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**k9diabetes** · 01-25-2010, 10:54 PM

Can a dog be insulin resistant

Jan 23, 2010, 03:37 PM

FROM IRONHORSE FARM

I just recently joined this list also so I hope I am not jumping the gun on a reply. For what reason did he have surgury? You may have an underlying condition. What are his other blood test values? ie, are his kidneys working properly. Has he been tested for Cushings?
I haven't posted a history of my diabetic dog yet but he went through an entire gamut of endocrine imbalances before we were able to regulate his diabetes. And, until we got the other issues under control, we were not able to regulate him. Insulin resistance was mentioned but that wasn't the issue with Sparky, it was other underlying health issues.

Donna

**eileen** · 01-25-2010, 10:58 PM

from Eileen

Marie, my suggestion would be to blood test Bruno since you do seem capable and willing. It is most definitely not a 'bother' and something that helps tremendously with glucose control. There are many sites on a dog besides the ear to try and draw blood...we can help you with that.

A consistant diet plays a huge role in their regulation, a specific insulin dose works with the caloric intake so must remain the same.
Are you not including any vegetables in his diet or added supplements? Dogs that are fed home cooked food require supplementation, vitamins and minerals. Also do be sure you are using brown rice, not white. You may also want to check into being sure you are feeding the proper proportions of rice to chicken to adding veggies.

I'm not following if you jumped from 9u to 12u at one increase. Altho with Bruno's size he will most likely need a larger dose that is quite alot to increase at one time. That equates to 6u more a day.

Are you aware of the recent FDA notices as well as Vetsulin telling vets to switch their clients FROM Vetsulin to a different insulin, namely NPH?
Vetsulin is becoming hard to come by and is my understanding that production has nearly halted if not completely halted.
You may want to talk to your vet about making a switch as it would be horrible to go thru all of this time and effort to try and get Bruno to a good place then have to turn around and switch insulins because of there being no product.

Eileen/Mildred

**overfiffty** · 01-25-2010, 11:01 PM

From Marie

Jan. 23, 5:56pm
_________________

Other than the ear and inside of the mouth where else can you draw blood. I did it to myself for years and have brand new equipment which was sent to me last month after my own surgery so I'm up and running.

Where else can you draw blood for testing besides the ear tips and inside of the mouth?

Thanks for your reply.

P.S. Someone mentioned Pumpkin which I will try to pick up tomorrow so that he has some of that.

Thanks everyone.

Marie & Bruno

**peggy0** · 01-25-2010, 11:01 PM

From Peggy

Jan 23, 2010, 5:58pm

i draw from the elbow pad

works great on big dogs

**eileen** · 01-25-2010, 11:08 PM

From Eileen

Jan 23, 2010, 6:08pm

Marie,

Many shave an area at the base of the tail...on top where it meets the body and find this an easy spot. I've always used Mildred's lip.

If you are to use pumpkin be very sure it is PURE and NOT the kind with added spices. Mildred loves pumpkin mixed with her broccoli and cauliflower.

Eileen/Mil

**k9diabetes** · 01-25-2010, 11:10 PM

From Natalie

Jan. 23, 2010, 6:11pm

Hi Marie!

Welcome to you and Bruno.

I will have to disagree quite strongly with your vet about 12 units per injection being on the high side for a 70 pound dog. On the contrary, I would say it's on the low side and certainly is capable of explaining why he's still not regulated.

I would say that the average dose for most dogs is somewhere between 1/4 and 1/2 unit per pound. Which would put the average for Bruno's size at between 18 units and 35 units.

I have run across some vets who seem to think half a unit per pound is high but I see it quite commonly as a good dose and have even seen some dogs who needed almost 1 unit per pound - which definitely is on the high side. But they were beautifully regulated on that dose. You use as much as you need.

If his blood sugar was quite high for some time, he may have suffered from some diabetic neuropathy, which in dogs affects the hind legs and usually resolves once you get the blood sugar down into a better range.

I'm also concerned about waiting an hour to inject. This is not typical. It is sometimes done if a dog gets a big kick from the insulin right away. Bruno might do better if he was injected immediately. With the rice in his meal, it seems unlikely that he needs a delay between eating and injecting. I'd say 95% of the dogs I've seen are injected right after they eat.

And then there's the rapidly disappearing supply of Vetsulin... We have just this weekend had the first report of a vet who cannot obtain any more. So Bruno is going to have to change insulins.

So... I have some concerns about the quality of the veterinary care that Bruno has been receiving and wonder if you have some options.

I would absolutely learn to test Bruno at home. Take a look at the tutorials here (give the videos time to download as some are large files): www.k9diabetes.com/bgtestvideos.html.

With Chris, as you can see from his video, we used the lip. Although I did actually have him lie on his side for testing. It was just easier to make the video with him sitting up. There are many different places to test. If he has an elbow callous, that would be an excellent one.

I'd like you to test so we can see how his food, insulin, and the delay in injecting are interacting. That infomration - from a "curve" - is how we can figure out what Bruno needs to get his blood sugar down.

www.k9diabetes.com/insulinfood.html

Natalie

**CarolW** · 01-25-2010, 11:13 PM

From Carol

Jan. 23, 2010, 6:37pm

Marie - I am SO GLAD, for your sake and Bruno's, that you found your way here. I'm sure you can see what I mean about lots of really excellent help being available here, from a whole bunch of people, many of them with lots of experience.

Aside to Donna and sparky - delighted to find you here, too!

I'm getting close in time now to Kumbi's Sacrosanct time - food and insulin to come - I have a few minutes still before all that starts.

So far, I think all the replies to you are excellent, and you can breathe a big sigh of relief, now that you have so many to help.

I agree with Natalie that it could really be to your advantage (Bruno's), to seek out a vet who is more up on diabetes than your current vet seems to be. I share the concern that Vetsulin will suddenly become unavailable, without warning, and Bruno and you will be up the creek without a paddle if that happens.

Also, do check out the tutorials here on testing BGs using a glucometer. I have every confidence that you will learn easily enough! And in your particular situation, it seems testing Bruno is agoing to be rather crucial.

Thanks for reporting in. Looking, now, for your further reports, as you are able.

Carol

Sat, 23 Jan 2010 17:36:47 (PST)

**CarolW** · 01-25-2010, 11:16 PM

From Carol

Jan. 23, 2010 6:54pm

Marie - you mentioned elsewhere that Bruno was given insulin very late - this morning, I believe - before your vet appointment?

Don't know if Bruno was fed at the same time (I believe you said your husband gave the insulin, after forgetting to give it at the usual time in the morning).

Assuming Bruno received 9 units of Vetsulin this morning before the vet appointment, much later than usual - food or no food - you now have a situation where the vet has suddenly increased the Vetsulin dose from 9 to 12 units. That's a large percentage increase.

Maybe Bruno won't run into difficulties, but I don't think you can count on that.

You could run into a problem with overlapping doses. I hope others here will comment on this potential problem. It should be a short-term one, UNLESS Bruno experiences a hypo. Don't want that, but you need to be alert to the possibility.

Do you know what to do if Bruno suffers a hypo?

Please keep us informed, and ask for help, night or day; often somebody is here, as there are members from various places in different time zones.

Sat, 23 Jan 2010 17:52:32 (PST)

SECOND HALF OF POST

Marie - again responding to information you have elsewhere, I'd like to say that I'm not happy that your request to your vet to change Bruno to NPH insulin fell on deaf ears.

Apparently your vet's response was something about his sending you to a specialist, and if I understood right, he said the specialist would tell you to put Bruno on 12 units - of Vetsulin, I gather!

That's possibly true, because specialists do vary - a lot, same as GP vets do. Just ask Natalie her experience with specialists, or, you'll come across it here and there, if you read other threads here, and I suggest you do that when you have time - every thread is very instructive and helpful.

Anyway, it seems your vet is completely unresponsive about changing Bruno to NPH from Vetsulin. And - for Bruno's safety, and YOUR devotion - I know you have it, same as all of us do - the sooner Bruno gets changed to NPH, the safer he will be.

So, you might truly need to search out another vet. Doesn't have to be a specialist, either, just knowledgeable and competent and experienced with diabetic dogs.

What I'm particularly sorry about is that this is pretty well ideal timing to be CHANGING Bruno to NPH from Vetsulin - BEFORE Bruno gets settiled into some particular Vetsulin dose, along with getting his food settled.

NPH insulin works extremely well for many, many dogs. Including my beloved Kumbi, who is on Novolin-NPH insulin.

Kumbi's Sacrosanct Time is just about upon us, so I'm off for a bit to feed him and shoot him in the back.

**eileen** · 01-25-2010, 11:19 PM

From Eileen

Jan. 23, 2010, 9:37pm maybe

Marie,

I completely agree with Carol....I tried to put it a bit softer in my earlier reply so to not step on toes.

But, now that it has been said I too think you need to find a vet that will listen to your request, if this is something you have already asked to do but only to fall on deaf ears (as Carol put it). It is pointless to continue working feverishly to regulate Bruno on Vetsulin only to have it pulled out from under you more likely sooner than later.

And for your vet to not support home testing is not acceptable.

NPH works wonderfully for many, many dogs. Several here are currently in the process of switching over from Vetsulin to NPH. I really think this is something you need to insist on doing...for Bruno's sake.

Eileen/Mil

**k9diabetes** · 01-25-2010, 11:24 PM

From Natalie

The jump from 9 units to 12 is a fairly large one.

Not that the dose is large - it is still quite small for his size. But the difference between the last dose and the new one is fairly large.

We really need some idea of Bruno's blood sugar levels... has the vet ever done a curve of his blood sugar levels for a day?

If so, please post the results - ask the vet's staff to give them to you if you don't have them already.

In fact, I would ask for a copy of his medical record - the vet notes and the test results. It would be good to have them in your own hands so you know exactly what has been tested and done and what the results are.

Plus, if you go looking for another vet, these records will come in handy.

And then I think it would very much help if you could keep trying to test him at home. With any luck, he has a callous you can use. That's a good spot of big dogs.

Also, though you think he might not accept the lip, you might be surprised. I didn't think Chris would accept it as he hated having his lip messed with. But there are virtually no nerve endings there and most dogs don't mind it a bit. I know Bruno may not have the same attitude - just thought I'd mention that he might surprise you.

Ears are possible but usually difficult in dogs.

Very shortly, whether a vet WANTS to switch dogs to another insulin is going to be academic. They are not going to be able to buy and those dogs are going to have to switch. I personally suspect it could be a year before Vetsulin is back on the market. So this is a critical thing to deal with.

If you peruse the threads here, you will see that quite a few dogs here have made the switch recently. NPH is a good insulin for dogs, often better than Vetsulin. It's just that a lot of vets aren't familiar with it.

I think it is time, in fact, to start a new poll on who is using NPH now as so many are switching.

Natalie

**overfiffty** · 01-25-2010, 11:25 PM

Update on Bruno

Jan. 24, 2010 a.m.
__________________

Hi Guys,

I gave Bruno 9 units last night at his normal time. Let me explain that I usually give him his shot(s) within a 30 minute time span after he has eaten his meal. I say between 6 and 7 because it can be 7:15 he eats and then I give him his shot at 7:45 give or take a few minutes either way. So more or less he's on a 12 hour schedule. Naturally if he eats at 7:30 the shot would be at 8:00.

This morning I switched to the 12 units. I shall watch him like a hawk today. I know should he become sleepy I need to put maple syrup on his gums till he comes around and I can feed him. As per the Vet.

I will test him later on this afternoon. Vet advised about 6 hours after eating. I'm not expecting any miracles from yesterday's 512 number. But I'll try to watch and yes I am going to be getting a small note book to keep track of all this stuff. Good idea asking for a copy of his records. I shall call the vet tomorrow and make that request.

I really like my vet and I can actually say I really trust him. He reminds me somewhat of a rebel personally and I really feel he knows what he's doing. I have to call him tomorrow for the results for that A1C test. Again, I forgot the doggie name to see how high his sugars have been for the past two months.

The vet asked me yesterday exactly how much Vetsulin I had left I explained I had just started a new bottle. The vet seems quite confident that he is not going to have a problem getting this insulin. I'm lost with this issue and I can't seem to get into his head as to why just start him on something else.

I shall keep everyone informed as to our progress today. I am praying and crossing my fingers we are not headed for any sort of problem. But since the lower doses of insulin have done absolutely NADA this should help.

Thanks to everyone for posting.

Marie and Bruno

**eileen** · 01-25-2010, 11:28 PM

From Eileen

Jan. 24, 2010 am

Marie,

Here is the Intervet (Vetsulin) website. These 3 letters were sent to every vet. The latest dated Jan.8th, telling vets that the supplies will be exhausted and to switch their current dogs to another choice of insulin...namely NPH.

Print it out, take it to your vet and ask him why he is so sure HE will be able to get Vetsulin when it is already hard to come by with other vets no longer able.

With careful treatment your Bruno has the potential to continue to live for many years with this disease...so your vet has another month or two worth of Vetsulin for you...what then, what happens when...and most likely he will, say to you, "I can't get anymore, you need to switch".

http://vetsulin.com/vet/Vet_ProductAlert.aspx

Eileen/Mildred

**k9diabetes** · 01-25-2010, 11:29 PM

From Natalie

Jan. 24, 2010, a.m.

From Intervet's most recent letter:

January 8, 2010

Re: Transition Assistance Via Independent Phone Consultation
Dear Doctor:

We appreciate all your efforts in transitioning your diabetic patients currently on Vetsulin� (porcine insulin zinc suspension) to other insulin products. As discussed in our letter dated November 30, 2009, *it is imperative that you transition all of your diabetic patients off of Vetsulin as future supplies of Vetsulin will be very limited in early 2010, and then exhausted.*

Following is the letter in PDF form so you can download it.

http://vetsulin.com/PDF/TransitionLetter01062010.pdf

This one issue alone raises serious concerns for me about your veterinarian... I know that is not what you want to hear.

But Intervet has made it clear repeatedly that they do not know how to fix the problem with Vetsulin and are not even certain the problem is with the insulin but rather may be with their testing procedures. Which means it could be a long time before it is resolved.

1-800-PetMeds advised back in December that it's supplies were running out and we now have one report from a member here that her vet is out of Vetsulin and is unable to purchase more.

Given all of this information, it seems to me that your vet is taking risks with Bruno's health based on... I don't know what it's based on...

Natalie

**k9diabetes** · 01-25-2010, 11:30 PM

More thoughts

Maybe he has stockpiled a hundred bottles and has few diabetic patients at the moment... that's really the only reason I can come up with for refusing to switch. And I still think it's a risky approach. A few bad bottles, as Peggy experienced recently, a refrigerator failure... many things could go wrong.

If Bruno was already well-regulated on Vetsulin, that would be a different story. Then it might... not absolutely, but maybe... be worth trying to stay on it with stockpiles. Some people whose dogs can't use NPH must and are doing that.

But it certainly does not seem like Bruno is well regulated on Vetsulin at this point. You could easily changeover now, most likely at the same dose of NPH as he is receiving of Vetsulin.

So I would really like to see the results of Bruno's curve(s) on Vetsulin.

If they looked fabulous, okay, then I could go with trying to stay with Vetsulin. If they don't... and I'm thinking you wouldn't be at forums looking for assistance if they did... why the vet's resistance to changing to a highly affordable, highly effective insulin that's reliably available when Intervet is practically begging him to do it?

I think the most important thing is for you to advocate for Bruno.

Set aside your feelings about the vet - not because he's a bad guy but because it is in Bruno's best interest to do so - and put Bruno's welfare as the top priority.

If it helps at all, I had to leave Chris' vet after his diabetes diagnosis. That vet is a kind, compassionate, intelligent person, and a good doctor. But he did not know what to do for Chris and he was not willing to be flexible in his approach to Chris' diabetes. One of the hardest things I ever did was change vets at that moment. That vet had saved Chris' life as a puppy. But I knew in my heart that we could do better for Chris than we were at that moment and that changing vets was the only way to do it. If I had stayed with the first vet and followed that advice, Chris would have suffered. So sometimes it's not about the vet being "bad" - just not right for this particular problem.

And I'm not even saying you have to switch vets.

But what you will have to do, for Bruno's sake, is become more assertive about Bruno's treatment and expect the vet to justify all of the decisions he makes with sound reasoning that's thoroughly explained to you.

It's not enough for him just to say, in so many words, "trust me." He needs to be able to back up his decisions with evidence and to explain why, in the face of Intervet's pleas for all vets to change their patients to another insulin, he believes this won't be a problem.

If he can give you good reasons, cool. If not, then I think you have to question his decision-making process.

Many people whose dogs have been diagnosed with diabetes have wound up changing vets. It's a condition that just isn't well managed consistently among veterinarians.

Okay, so I will stop bombarding you! I know this is a bit of a pile-on. Only because we are very concerned.

Natalie

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Bruno crossed over the Bridge this morning

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