A "People" Perspective!

[forscooter]

Hi Everyone!!!

I'm Beth, and hopefully I won't screw up my first post!

I was "talking" to Natalie over on the Cushing's board, as I have two dogs with Cushing's disease (Scooter and Bailey)....and I, myself, am diabetic. I have been trying to help the diabetic pups and their moms and dads by offering what I know about diabetes from a "people" perspective...what it's like, how it feels, what can help, etc....especially since a doggie can't tell us!

I admit I know very little about canine diabetes, but I thought I would offer any help I can to any of you who may have questions that maybe your pup can't tell you. So, some things may be different, but I think a lot of things are the same and hopefully I can be of some use.

Jeanne, Kiska's mom, asked me about insulin and what it feels like. I thought I would give you all a copy of my answer here. I will also add on this thread other information I have given her in the hopes it helps someone here too!

And....please feel free to ask me anything about how it feels, what it's like, what I know, what I don't know...I am more than happy to share anything I can.

Just a quick background on me....I am a diabetic for ten years. First treated with oral meds (misdiagnosed as a Type 2), then went onto injections and was up to injecting four times a day with different combos of insulin, and then I went onto using a pump. I am still on a pump and now also have a glucose sensor that goes with it. I have been as low as 11 (and still standing somehow ) and as high as the upper-500s (and still standing somehow )...I have had ketones, and all sorts of things. So hopefully my experience will help all of you!

OK, this is what I told Jeanne when she asked about the insulin, giving injections and how it feels to be hypo and hyperglycemic:

"I don't know about Kiska but I can tell you from a people perspective! Insulin itself doesn't hurt per se...it's more about sometimes hitting a nerve when you place the needle. And since you can't see where the little buggers are, sometimes you hit one! Cold insulin, or refrigerated insulin, can be more uncomfortable...so if you keep it in the fridge, it helps if you roll the bottle gently between your palms first before giving it. I use mine so much that once I open a bottle, I keep it out of the fridge. But when I use a new one, I "warm" it first. I never noticed a difference between the amount of insulin hurting more....just more where the needle goes.

When I have hurt myself, sometimes it is a quick sting, sometimes I scream OUCH OUCH OUCH and jump around......BUT any pain passes very quickly. It helps to rub the spot where the injection went to get rid of the pain faster. A quick fast jiggly rub!

As for how it feels....it doesn't really feel like anything. If your sugar is high, and the insulin does it's job bringing you back down to closer to normal, you just feel more awake, not as thirsty, not as crummy, more energetic, etc. If it doesn't, you just still kind of feel ho-hum. If you go too low from too much, you feel lethargic and hot and very hungry...sometimes dizzy, numb/tingly. And if you ever rollercoaster, up and down and up and down, you just feel like pure garbage!!! I usually get a headache and feel like a wet noodle bc then the body is more like WHHOOOAAAAAAAA!

So...you don't want to drop too quickly either bc you can set things in motion to go too low....what you are doing is fine!! It's right!! Slowly adjust the insulin up, fiddle with the diet but not to the point where she is hungry, and you will get there! Better to take your time in getting it down. I don't know about doggies, but for people, a slow decrease is better than a very fast one....it just makes you feel badly.

I find if I take the needle out before releasing the pinched skin all the way helps with the pain too. Taking it out while the skin is still pinched up hurts me more for some reason...I don't know why, but it does..." I also want to add here that when you keep the pinch and take the needle out before releasing the pinched skin, it tends to get that wet spot that pushes some insulin out I think.

I hope this is helpful to you! And I will be back with some more pointers as I sort through them!

Thank you SOOO much for having me here!! I'm very happy to "meet" you all!
And I'll try to get some pics in here too!
Lots of hugs!! Beth (and of course, my Scooter and Bailey!)

[fatdog55]

Re: A "People" Perspective!

Beth
My dad was a diabetic for probably 15 years, and a cousin is a diabetic since she was a teenager…
Gotta tell you, I have never seen or heard of anyone put into words what you have, and so very succinctly.
I think this should be a sticky, as it really deserves to be read MANY times by all.
It's a good lesson.
Thank You
Paul

[johanna]

Re: A "People" Perspective!

Beth....
Great post.... You have given a lot of good pointers.... I will not take the needle out again before letting go of the pinched area.... Thanks for that !
My sister in law is also a diabetic and she keeps insisting that you MUST eat !!!
She always argued the theory of our dogs getting 2 meals a day......
Keep sharing your diabetic experiences ... after all our dogs cant tell us....
Killian just said " Thanks Beth !!!

[ladysmom06]

Re: A "People" Perspective!

Hi Beth,

Happy to see you here. You have given me some good pointers this last year with Lady and I'm sure you'll be a big help here. Lady is happy to have you and the boys here too. Hugs to you, Scooter and Bailey.

[Ricksma]

Re: A "People" Perspective!

Thanks, Beth, for all the information. I actually have a very close friend who is diabetic, and we have had many conversations about how it feels to go low, go high, and everything in between. It is a terrific help to know how blood glucose is making my Rick feel...the other day he dropped too fast from a higher number, and I knew that he felt bad all evening, and I knew why. Thanks so much for sharing.

Love and hugs, Teresa and Ricky

[Kiska'smom]

Re: A "People" Perspective!

Hi Beth,

Now you are a star on this site, too! Thanks for being so willing to help. For those who don't know, Beth has two doggies with Cushing's disease. She has been one of my angels of support on the CanineCushings.net website. Now she's here helping all of us with our questions about diabetes. She is one of the nicest, more caring people that I know. Once you get to know her, you will also see how funny she is. She keeps me laughing when I'm feeling down about Kiska's health. She has more on her plate than you can imagine; but she's always willing to help and share her time and knowledge. I'm seriously voting for saint-hood status! Ha! Honestly, this board is so fortunate to have her here. Beth, I'm sending you another bone-crushing cyber hug for all that you do. Thank you!!!

Jeanne and Kiska

[ladysmom06]

Re: A "People" Perspective!

Hi Beth,

I agree with Jeanne and I'm also voting for saint-hood status. We are all lucky to have you here with us.

Beth and me both started treating our pups around the same time last year for cushing's. Over this past year she has always been there for me and so many others on the cushing's board. Having her here with us will be a really big asset to this board. Thanks Beth for being so willing to help. Hugs to you and the boys.

[Dollydog]

Re: A "People" Perspective!

Hi Beth,
It is so great to "see" you here and read your post. I agree with the others who say you will have sainthood status here too!!
Now I understand why there is that little bit that comes out after the injection. I'll have to watch that tonight. I am constantly learning about this disease and how to treat it.
Thank you so much for your post, take care,
Jo-Ann & Lady

[forscooter]

Re: A "People" Perspective!

Ah, thank you all sooooo much for the warm welcome!!!!
And, sainthood??? Ummm...maybe put in a few good words for me then??? BC I was kind of bad today!

I am so very happy to be here with my friends, and with my new friends, and anything I can do to help, I'll be here!

And Johanna, yes eating is very important to help not go too low...but I also am a big believer in tailoring the insulin to the diet as well as the diet to the insulin. The most important thing is what works. So, I do understand your sister-in-law's concerns about the two meal a day thing, but as long as the insulin is given to kick in when the food has been consumed and those blood sugars are going up, it should all be good.

So many things can influence blood glucose levels. Stress, illness, hormones, the way the wind blows (OK, maybe not that!) can all impact blood sugar. And sometimes, things can be a bit out of whack "just because". So, this is why I think food is just one part of the picture. Individual metabolism varies as can metabolism on any given day for a variety of reasons.

Sometimes, when I am under stress (not that I have any..right Jeanne, Lynne, Jo-Ann???? ) my blood sugars can run really high or really low...or from really high to really low really fast. And I never know which way. One of the reasons I got put on this sensor bc they don't know what to do with me! And there is only one way to really know which is to test.

I think I am actually following in Jeanne's footsteps here...my good boy, Bailey, bit my hand for the first time last night (I startled him when he was sleeping....and all day long my mom's voice was in my head, "Let sleeping dogs lie")...and Kiska and I seem to have some trouble following the diabetes "rules"...

I am looking forward to reading all about all of your pups and catching up with all of you! Tonight, I seem to have one of those darn headaches Jeanne is also sharing with me, so I will be back!

Hey, are we allowed to share chocolate on this board??? BC we always send each other hugs, chocolate and margaritas on the other board...well, until I know, I wish you all a great night!!!
And....lots and lots of hugs!!!!!!
Beth and the boys

[Kiska'smom]

Re: A "People" Perspective!

Ah, Beth,

Sorry to hear about the headache and the Bailey bite! My kitty, Suki, bit me tonight, too! I accidentally clobbered her in the face when I was reaching for something on the countertop where she was sitting. It took her a minute to figure out that she was really P.O.ed; then she bit me on the arm and my leg! Not too hard, just enough to let me know that she was not impressed with my aim! Is there a full moon? Maybe it's in the water!!!

Kiska's teeth are on loan to Louise and Munchie on the other site. They have been requested to bite the stuffin' out of her IM vet, who "done her wrong!" So, I guess that I'm safe from Kiska, at least for tonight! Ha! She still isn't following the diabetes rules, but at least her numbers went down a smidge tonight. You wouldn't think that I'd be excited about 415, but I am. She started out this morning at 468 (7:00 a.m.). Then at 9:15, she was at 487. By 2:00 p.m., 445; and tonight before dinner 415. That's a pretty flat curve. Too bad it's not about 300 ticks lower! How the heck do you get there???

When you get to feeling better, I'd like to hear about your pump and sensor. How does all of that work? I don't think that there is anything like that for doggies yet. I'm sure that I couldn't afford it, even if there were! When did you go bionic?

I think that you should be the first to introduce cyber hugs, chocolate and margaritas to the group! I know that they always make me feel better!

Okay, I have to ask before I close...how were you bad today? I hope that it was lots of fun!!! You have to make those headaches worthwhile! Get some rest! I'll talk to you tomorrow!

Hugs, chocolate, and margaritas all around!

Jeanne and Kiska

[forscooter]

Re: A "People" Perspective!

Now if I told you how I was bad, you wouldn't make me a saint now would you??? LOL

I'm happy to tell you about my pump and sensor. I've been on the pump since 1999, just got my new and improved model a year ago. The sensor I just got a few months ago....which I thought would be a great thing...and it is...BUT, when it alarms all night long, a happy Beth it doesn't make!

My pump works by delivering insulin 24/7. I use Humalog, although many people use Novolog in the pump. Every three days or so, depending on how I am eating, I fill a reservoir (looks like a fat syringe) with insulin. That gets attached to this thin tubing which has a needle on the end. The reservoir goes into the pump. the needle gets put into my stomach or leg or wherever my next site is. The needle comes out and this little tiny bit of plastic stays in to let the insulin through. The pump is programmed to deliver a "basal" rate of insulin...this is the amount I need to just keep breathing and moving. You can program different rates for different times of the day if you need to. My rate changes 5 times a day. I need more insulin starting at 3am bc I have a very bad "dawn phenomenon" where my "wake-up" hormones make me more insulin resistant. Then I go to a lower rate at 9am and so forth.

When I eat, I put in the amount of carbs I am going to eat, and the pump figures out how much insulin I need to cover them (this all of course if programmed in there by me and my doc). I can also put in what my BG is and the pump will also calculate how much insulin I need to cover the high sugar if it is high. I can over-ride the pump at any time I need to. I can also set to have my mealtime insulin delivered over a period of time so if I eat a higher fat meal, for example, or a carb that tends to make me go higher later (like pasta for me) then I can get that bolus to give me some now and some over the course of an hour or two or whatever I want/need.

The sensor I had to fight with insurance to cover bc it is very new. I was the first one in the country to have my particular health insurance cover it bc I fought with them for it! Anyway, that is inserted with this needle thing too but then you pull that out and this tiny strip of what looks like test strip material stays in under the skin. I attach a transmitter, about the size of a quarter to it. It transmits my BG to my pump every 5 minutes. I have to calibrate it twice a day bc it measure the glucose in the interstitial fluid whereas the meter the blood itself. It alarms when the BG are getting too high or too low. And it shows you with arrows on the pump when the sugars are rapidly falling and rising. It has to be changed every 6 days.

You can then download all this info to your computer and print out all sorts of pretty graphs that show your trends, etc. Except I am so busy with "life" right now, I don't journal as much as I should which would give an even better picture. Right now my sugars are very out of control which they think is bc of all the stress and the perimenopause so we are trying to figure me out!

I can shower with the sensor but not the pump, so I just temporarily disconnect.

They should have one for doggies!!!! It has helped a lot before my life went haywire!

And you get where you need to be just by trying different combos and schedules and doses. The problem is every person/doggie is just so different...it takes some time. But I also read your thread and I think you got some really terrific advice! Maybe a different type of insulin is the way to try...and maybe a different time?

Do doggies only use a long acting insulin or is there a shorter one too like for meal coverage? BC I am wondering if there is, if maybe you need both?

OK.....ready??? Here they come!!! Margaritas and chocolate and tons of hugs!!!!
Beth and the boys

[Kiska'smom]

Re: A "People" Perspective!

Hi Beth,

Ahhhhhhh, my nightly fix of margaritas, chocolate and hugs! Many thanks. I feel better!

I really don't know anything about the different kinds of insulin. I have been trying to keep up with Johanna's combinations, but I don't understand exactly what she is doing. I have only been giving the Novolin N for a month. I need to see my vet to give him an update. The problem is, he only relies on fructosamine tests to see how Kiss is doing. He says that testing blood glucose doesn't give him as accurate a reading. This little test is about $50 or $60 dollars a pop. He wants to do them every two weeks, but I haven't been back. Not only are they too expensive to do that often, I don't see why doing curves wouldn't give him enough information to go on. It's going to be one of those uncomfortable discussions when I finally make the appointment.

He also doesn't seem the least bit concerned that her BG isn't getting into a managable area. He just says that dogs are rarely regulated on the first try. He was actually a little indignant that I asked about that. It was as though he felt that I was attacking him. I wasn't. I just wanted to understand the process. He also brushed off my concern about Kiska's eyesight. I really wanted to get her diabetes under control and try to save her vision. He just said that she would definitely get cataracts and lose her sight. It's inevitable. Needless-to-say, I was bummed.

So here I am a month later, still feeling like quite the novice. I guess all of this can get quite complicated. That's okay, it's just going to make life a little harder, especially when Mike has vacation time and wants to travel. Clancy did a great job looking after Kiska for a week, but her insulin and meals worked well with his work schedule. If things change, he would not be able to help out. So there is a lot to think about and plan for.

Wow, your pump and sensor are really high tech! I'm glad that you were able to get them and have them covered by insurance. My guess is that they were expensive!!! Being the first in the country to have the sensor covered by insurance is quite extraordinary! I'm impressed! :-) I'll bet that was labor intensive!

How is the Bailey bite? Are you still calling him Killer? LOL! My kitty has been hiding in the linen closet all evening. I'm not sure that she has forgiven me yet!

Thank you for the description of your equipment and how it works. It's amazing! I'm glad that you have it and that it has helped a lot. It should have a program called, "DEFCON FOUR," for those special occasions when life goes straight into the toilet! Ha!

I'll check back and see if anyone else answers your questions about the different insulins. Natalie has talked about them and how she combines them, but she's a lot farther down the road than I am. I'd be afraid to start mixing insulins unless I really had a handle on what I was trying to accomplish and what I needed to watch for. I'm sure that day will come. It's just not going to be tomorrow!

We'll have a margarita to celebrate when I get to that point!!! Until then, it's chocolate all around!!!

(There's no way that you could lose your sainthood status! Be as bad as you like, I'm still your biggest fan!)

Hugs,

Jeanne and Kiska

[k9diabetes]

Re: A "People" Perspective!

Hi Beth!

What a joy to have you here! You have such a great combination of invaluable experience and a generous, caring, and very funny nature.

Whew... every time I hear a diabetic person talk about what they go through to manage their diabetes... I think thank goodness I only have a diabetic dog! It's a lot to keep track of.

Do doggies only use a long acting insulin or is there a shorter one too like for meal coverage? BC I am wondering if there is, if maybe you need both?

Dogs have been managed so differently... and to a degree, indifferently... Their status as pets and as animals often left home alone for a day or more at a time has shaped how their diabetes is controlled. For years they have been put on high fiber diets with the goal of extending their digestion of their food to more or less match the longer acting insulins. And "regulation" is often defined as getting their blood sugars down into the 200s at the lowest so that they are never at risk of hypoglycemia.

Vets usually have discouraged home testing of blood glucose too.

Endocrinologists argue that since dogs do not experience most of the severe side effects of uncontrolled blood sugar, if only because their lifespans limit how many years they live with it, there is no need to tightly control their blood sugar.

From what I've seen over the years, a lot of dogs really don't need faster acting insulin. They can get fairly level blood sugar from straight NPH and from Humulin L when it was still available. I think the theory is, too, that the slight difference between human insulin and dog insulin may create some resistance that slows down the action of the insulin.

Vetsulin, is a molecular match to a dog's insulin and is a lente insulin so it's 30% semilente and 70% ultralente crystals. Possibly because of a combination of the exact molecular match and it being a U40 insulin, Vetsulin has caused some sharp drops in dogs' blood sugar during the first few hours, especially if it's given with a high fiber food.

Cats process the insulin very quickly - they pretty much have to be on very long acting insulins like Levemir or Lantus or PZI to get any duration.

I rely on trends generated by curves to decide whether some faster acting insulin is needed. If there's a huge post-meal rise in BG, then it can be helpful.

Probably the bigger problem for dogs is lack of duration.

NPH works really well for a lot of dogs but 12 hours is about the most they can get out of it and some get quite a bit less. Chris got 8-9 hours from NPH. Given three times a day, it worked great (but he was allergic to it). I think there are a bunch of dogs out there who would do better on NPH if it was given three times a day instead of twice but for many people their work schedules just make it impossible. Those kinds of issues dictate much of how a diabetic dog is managed.

Regular lasts Chris about 6 hours so we give it four times times a day. He's on a diet of canned food that has limited grain (only brown rice) plus ground beef or chicken. The canned food does give him a spike after eating but we live with that as his blood sugar is in a good range all day and the spike doesn't last too long.

I actually love using Regular because I don't have to worry about extended time that insulin remains and overlaps. I'd like to get more sleep but more than two years into this routine I've kind of gotten used to it and it works well for Chris, allowing us to keep his blood sugar mostly in the 100s.

There is a dog who has been treated at UGA who has had the continuous glucose monitoring system hooked up for some days at a time. We considered it early in Chris' regulation problems... it was just coming out then. Now we just test fairly frequently. 3-4 times a day plus other times if we're concerned or want to see what his BG is doing at odd hours. He's had so many health issues that I haven't bothered with a full-blown curve in a long time as things are always changing for him.

In truth, I don't think most vets know a lot about managing blood glucose because it's not something they are taught or even encouraged to learn. I'm hoping that will change...

Natalie and Chris

[Ricksma]

Re: A "People" Perspective!

I agree with Natalie here that most vets are not well-versed in diabetic care for whatever reason. The vet who diagnosed Ricky told us that he could get one shot a day, and possibly his blood glucose could be controlled by diet alone, and he could stop insulin.. We all know that neither of these things is true. I use 1/2u of R insulin combined with 3 1/2u N, but only if Ricky's blood glucose is over 140. I am here with him all day, and I am available to check him to be sure he's not going too low. For most people, the N works fine. I decided to try combining the insulin because I saw a big rise with Ricky after meals, and I just wanted to level that out to give the N time to start to work. So far, it has worked well, but I'm not sure I would recommend it if you are not there with Kiss. As Natalie will tell you, R is strong and quick.

Love and hugs, Teresa and Ricky

[Ricksma]

Re: A "People" Perspective!

Beth, You have an amazing amount of technology working to keep you going....there you are, the bionic woman!! Thanks so much for all the information. It really helps to understand what is going on. I hope your hormones settle down (for more reasons than one, LOL) and allow you to get a little more evened out.

Love and hugs, Teresa and Ricky