Insulin Requirements

[fatdog55]

For those who have been fortunate to have a regulated ( or reasonably regulated ) pet, how have the insulin requirements changed – if at all?

It took about 4 months to get Zip regulated, and he has always used NPH.
He was on 22.5 units twice daily for about the first 8 or 9 months, than his needs started to increase.
Now 3 years later, he is up to 32 units x 2, which is not bad at all for a 100 lb dog – but his needs have increased.

I just had to increase him again by 1 unit x 2.
This is the first increase in the past 5 months.
Nice curves, with few complaints about the readings.

Food intake is the same ( about 1200 cals daily ) which consists of about 8 % carbs.
Activity about the same.

Just wondering how the other long termers have done.
Paul

[k9diabetes]

Hi Paul,

I don't know how helpful this comparison will be since Chris' diet, health, and activity levels have changed a lot of the past three years but I'll list it anyway.

I suspect that both thickening of the skin at the injection site - Chris got this extensively and quickly in the scruff but after several years now he has some on his sides where I inject now as well - plus scar tissue and possibly some slowly developing resistance could all play a part in making them require more insulin. Plus inflammation from arthritis... could be a lot of little things combined.

For what it's worth, here's Chris' history...

Chris started getting Regular insulin four times a day in June 2005, so almost three years ago.

Once we settled on a consistent diet, around November 2005, he was using between 5 and 6 units of insulin per injection.

Around September 2006 he started needing 5.5 to 6.5 units.

By spring of 2007, which is when his heart and lung issues got a lot worse, he was using more like 6 to 7 units.

Then in July 2007 he needed more like 7 to 8 units.

There were various diet changes over those years. Spring 2007 he didn't want to eat at all and his diet was erratic. July of 2007 he was getting ground beef and Canidae.

He also gained some weight as his activity decreased pretty significantly. So this spring I cut his food portions back and he lost some weight.

After switching the ground beef to cottage cheese a week or two ago, his insulin needs dropped some, down into the low 7s and high 6s.

Not huge changes but percentage wise from such a small dose they are fairly large.

I'm changing his diet again, to rice and chicken for now. I calculated equivalent calories and it turned out to be almost the same amount of food in terms of volume and then cut his insulin half a unit. On chicken and rice last night and 6.5 units his blood sugar was 115 this morning at his 5am meal.

Natalie

[We Hope]

Hi Paul,

I don't know how helpful this comparison will be since Chris' diet, health, and activity levels have changed a lot of the past three years but I'll list it anyway.

I suspect that both thickening of the skin at the injection site - Chris got this extensively and quickly in the scruff but after several years now he has some on his sides where I inject now as well - plus scar tissue and possibly some slowly developing resistance could all play a part in making them require more insulin. Plus inflammation from arthritis... could be a lot of little things combined.

For what it's worth, here's Chris' history...

Chris started getting Regular insulin four times a day in June 2005, so almost three years ago.

Once we settled on a consistent diet, around November 2005, he was using between 5 and 6 units of insulin per injection.

Around September 2006 he started needing 5.5 to 6.5 units.

By spring of 2007, which is when his heart and lung issues got a lot worse, he was using more like 6 to 7 units.

Then in July 2007 he needed more like 7 to 8 units.

There were various diet changes over those years. Spring 2007 he didn't want to eat at all and his diet was erratic. July of 2007 he was getting ground beef and Canidae.

He also gained some weight as his activity decreased pretty significantly. So this spring I cut his food portions back and he lost some weight.

After switching the ground beef to cottage cheese a week or two ago, his insulin needs dropped some, down into the low 7s and high 6s.

Not huge changes but percentage wise from such a small dose they are fairly large.

I'm changing his diet again, to rice and chicken for now. I calculated equivalent calories and it turned out to be almost the same amount of food in terms of volume and then cut his insulin half a unit. On chicken and rice last night and 6.5 units his blood sugar was 115 this morning at his 5am meal.

Natalie

I have two good friends who have been living with diabetes since they were kids; without going into their ages, let's say each of them have been using insulin for 50 years or more. They've both seen their needs increase over time; anyone who has liver or renal problems can see their needs decrease because their system doesn't metabolize the insulin as rapidly.

http://www.inchem.org/documents/pims/pharm/insulin.htm#SectionTitle:6.4%20Metabolism

"Severe impairment of renal function appears to affect the rate of disappearance of circulating insulin to a greater extent than does hepatic disease."

It may be that some retain a few working pancreatic beta cells--not enough of them to support the body without insulin shots--but some that are still functioning. Over time, these remaing few beta cells may die out, just as the majority of them did to produce diabetes.

We also get into insulin resistance:

http://web.archive.org/web/20061101024441/www.diabetesincontrol.com/issue178/bern178.shtml

Dr. Richard K. Bernstein--The Laws of Small Numbers

"When you inject insulin, you’re putting beneath your skin a substance that isn’t, according to your immune system’s way of seeing things, supposed to be there. So a portion of it will be destroyed as a foreign substance before it can reach the bloodstream."

Even if you're using an insulin which is a total amino acid match to the insulin your body came with, the immune system is smart enough to know that the injected insulin wasn't made by the pancreas. Most of the time, this creates no major problems because enough of it gets into the bloodstream to do the work of controlling blood glucose.

http://petdiabetes.wikia.com/wiki/Insulin_antibodies

Over time, the immune system remembers the "invader" and its "strategy" for dealing with it previously:

http://www.peteducation.com/article.cfm?cls=2&cat=1614&articleid=957

"Adaptive immune system: In addition to the innate system, dogs, cats, and other animals including humans have an adaptive immune system. The adaptive system defends the body against specific foreign invaders, designing different tactics for different invaders. The parts of the adaptive system communicate with each other and develop a memory of the various invaders they encounter.

"In our castle analogy, the adaptive immune system would include archers, spear-throwers, cannoneers, and swordsmen. They each use different tools and defend against those invaders for which they are best designed. They remember previous battles and can improve the speed and efficiency in which they defend the castle."

So over a period of years, the "invader" enters the body at least twice a day and the immune system continues to raise its objections--you wind up using more insulin to overcome them.

Using the same injection site(s) interferes with the proper absorption of the insulin--making it take longer to get down to its job:

http://petdiabetes.wikia.com/wiki/Regulation_problems#Injection_problems

When shots are given again & again into an area of skin, the tissue becomes thicker at that point; a fairly good analogy would be the calluses people get on hands and feet. The callus skin is thicker and harder; injection areas become similar to this too from repeated shots. This thicker, harder skin doesn't let the body absorb the injected insulin as well as thinner, non-hardened areas.

HTH!

[Denise]

Hi Paul!

Bogie was dx'ed in 09-2001 and by April of 2002 he was pretty well regulated on 12 units NPH twice a day and eat (gasp) WD! This is when he had his cataract surgery and they wanted him well regulated before doing the surgery. We switched to Eukanuba rX food and insulin stayed the same. He was on 12 units until late 2004 when I suspected Cushings but the tests wouldn't prove it but now eating home cooked.

We got up to 16 units and sometimes had to use R cause he'd get so high. While trying to treat the Cushings he still required 16 units but after stopping Cush meds and messing with his diet we got him down to 13-13 1/2 units. He hasn't wanted to eat what I wanted him to now for months so we stopped the home made and have used canned, kibbles with added veggies at times. Right now he is getting 12 units and eating Flint River (the past 2 days) the food he'd eated for years before dx and is only needing 12 units. Go figure!

I used to notice thickening of the scruff area, not too long after starting insulin but now there aren't any areas that feel thickened to me. I tried using his side area and a nice, always compliant dog about had a fit!

I'm glad Zip is doing well!!! I don't think 32 units is much for his size and I think you've done a great job!

[BestBuddy]

Hi Paul,
When Buddy was on Caninsulin he was pretty regulated on 4.5 units. Over a year ago we changed to Humlin N and he had only been getting 3.5-4 units until the last month or so and he is now getting 5 to keep his BG controlled. It may not sound like much of an increase but Bud is only 11lbs.
Jenny & Buddy

[eyelostit]

I never could get good BG readings with Niki, her BG shoots low at 2-3 hrs, then at 4-6 using NPH

I could never get her regulated with all dry dog food, it was just never gonna happen. I tried it all, all foods, timing of injections, treat during the lows.

Diag 2003 Purina DCO during treatment went up to 18-14 units, back down to 14-9 still BG high, still leaking pee

August 2005 New vet 11-11 units, still HI BG on Eukenuba from vet at this time, still leaking pee

After a while I just got PO and took Niki's health in my own hands adding meat and taking away some dogfood getting readings of 180 + no more 300+

Finally the adding of vegetables 120-180 finally brought her down, sad part is she went blind in 2006.

New vet seen the results, and showed her the Glucopet meter to compare BG

My lesson learned, the 1st. vet didn't pay attention to Niki's health, earlier on I could of feed the veggies, improved her DB and could of ? suppressed her blindness, I think she would see today, if the 1st vet would of advocated about homecooking or adding vegetables, which I see now works for Niki. Or the vet who gave her Detrol for urine leaking without doing an additional BG test.


Damn I think back then in 2003 if I would have added meat, or just some veg to her dry dog food could of solved alot of her highs.

Ah ...what are you gonna do, but learn from the experience, my warning signs from the vet were they kept uping her insulin and the BG was not coming down into the 180 range at all.

I make her gr. turkey and chop her veg in processor about every 3 days, it gets hectic at times, I wish I didn't have to do this, but then Niki would no doubt not be here with me now. Is just a shame they all don't regulate the same way.


you can read Niki's story at the main page Diabetic Dogs storieshttp://http://www.k9diabetes.com/storynikid.html (http://www.k9diabetes.com/storynikid.html)