On NPH vs Vetsulin

[brewerdl]

My Keeshond has been on Vetsulin for about 2 years (never as well controlled as I would have liked). My vet switched her to Humulin N about 10 days ago. I was using u-100 syringes for the Vetsulin - converting her dose back to u-40 she was getting 18 U AM and 16.8 PM. He started her on 4 U BID of Humulin N (way too low - her blood glucose readings were in the 400s). I have gradually raised her dose to 12 U and expect to have to increase it more (she's still running in the 300s). My questions: Are most of you that have switched to Humulin using close to the same dose as Vetsulin u-40 dose? Also, I have to leave for a business trip on Saturday and will have to board her at the vet's while I am gone, so I don't think I should increase her dosage more until I return and can monitor her more closely. Any thoughts on this? The vet doesn't seem to be concerned with numbers in the mid 200-mid 300's - - - I like to keep them lower if I can. What numbers are most of you trying to achieve? The last question: I talked to another vet and they have secured a supply of Vetsulin, so she suggested I go back to it. My initial instinct is to keep trying the Humulin N to see if I can get better control, but I would love some feedback from others who have used both. Have some of you had bad experiences with Vetsulin? I felt like the vetsulin wasn't consistent from bottle to bottle sometimes. Magil is 12 years old and is almost completely blind now I appreciate any insight or suggestions from any of you!!!!
Last thing - - WalMart isn't the only place to get deals on diabetic supplies. If you're lucky enough to live in a town that still has an independent pharmacy, stop in and talk with your pharmacist there - - -many times you will get much more personalized treatment & advice and can often get free - or very inexpensive - blood glucose meters and good deals on strips & insulin. (I'm paying half what I paid for Vetsulin and can probably get the Novolin a bit cheaper than that.) Sorry - I just hate the way WalMart has become such a monopoly ---- that's traditionally not so good in the long run (Hope I haven't offended anyone with my opinions!!!) THANK YOU FOR ANY HELP with Magil!!!!

[brewerdl]

Re: Switching From Vetsulin to Humulin N

By the way, I forgot to introduce myself - - my name is Deborah :-)

[k9diabetes]

Re: On NPH vs Vetsulin

Hi Deborah,

I started a thread for you and Magil. Welcome to the forum!

Here's my feeling about NPH - it's a wonderful insulin for most dogs and costs far far less to use and so I wish that all dogs were started on NPH and then moved to Vetsulin if NPH doesn't work for them.

So in Magil's case, I would opt to see what NPH does for her before trying to switch.

I am wondering how your vet got hold of Vetsulin. My understanding is that the critical need program has been under incredible demand and I don't imagine FDA is just letting the vet buy it.

I would like to see vets avoid just putting dogs who can use NPH back on Vetsulin as that will deplete supplies for dogs who can't use NPH who truly critically need to have it. Our dog (no longer with us) was one who could not use NPH as he was allergic to it.

Most people who have switched have wound up at about the same dose of NPH as they were giving of Vetsulin. But a lot depends on how the Vetsulin was working for your dog and how tightly regulated she was. If, for example, she wasn't making good use of the Vetsulin, she might do better on NPH and get better blood sugar with less of it.

We have been recommending reducing the dose about 25% when switching so your 12 units is probably closer to that recommendation.

I like to see a target blood sugar of between 100 and 200. There are plenty of dogs who aren't capable of achieving that but it's a good goal. If your dog can't get to that, then as close as possible is the next best thing. If there's not a good insulin/food balance, the curve can have extremes of high and low blood sugar that make it difficult to get overall good levels. But if the curve is fairly flat, you usually can increase the insulin and get there. Sometimes a diet tweak can help.

I'm glad you've had good success outside of Walmart. I understand the dislike of Walmart's policies. We held out for quite a while, but when Chris was on a half a dozen meds for heart disease and cataracts, the bill hit about $200 a month and would have been more like $300-$350 at other name-brand pharmacies so we caved.

You should save enough on the NPH over Vetsulin to never have to use Walmart!

Natalie

[CarolW]

Re: On NPH vs Vetsulin

Deborah, I'm glad for your thoughts, for instance, about Walmart! And glad for your care of Magil, which seems to me very good. I love those Keeshond dogs!

I'm with Natalie - and you - on sticking with the NPH insulin. My Kumbi certainly did well on it. He was started on it, so I don't have any experience with Vetsulin (or Caninsulin, as it's called here in Canada).

It wouldn't surprise me if the vials of Vetsulin had varied. People used to remark on that even before the FDA closed down its shipping in the U.S.

Bet Magil is a dear dog! Give her a big hug from me, and from Kwali and Kumbi, licks and wags - and here's a hug for you, too!

Wed, 11 Aug 2010 20:43:29 (PDT)

[brewerdl]

Re: On NPH vs Vetsulin

Hey Natalie - found the thread First of all, THANK YOU for some good information!!!
It is my understanding that the vet heard that Vetsulin would be going off market and stocked up. She said that the NPH was a shorter acting insulin, but from what I've researched, the onset, peaks and duration is similar - - it looks like NPH is a smoother curve, where Vetsulin has 2 more distinct peaks. I'm not sure if that's better or worse.
What kind of food tweaks? They have had Magil on the WD dry food. My vet says it's ok to give her a small amount of lean meat occasionally. He also has said it probably won't hurt to put just enough shredded cheese in the food so that she picks up the scent and eats better. AND - - her favorite thing is one greenie (regular size bendy ones) for a treat at bedtime. He ok'd that also - - - if that's not good, I'll have to come up with something comparable or never sleep again!!!! :-) (She's just a BIT spoiled). Do you have any suggestions for food tweaks???
Thanks again!!! I'm so glad I found this site!!!!

[brewerdl]

Re: On NPH vs Vetsulin

Hi Carol! Thanks for the reply!!
This is my 5th Keeshond and it seems the most spoiled of all. Since she lives inside with me, it's pretty much HER house - she just lets me live here!! :-)
Thanks for the hugs, licks and wags!!!! Back at you!!!!
I'm headed to bed now - will check back tomorrow. I'm so thankful to have found this forum and such great & helpful people!!!!!!!
My favorite musician is from Canada :-) (Neil Young - do you like him???)

[k9diabetes]

Re: On NPH vs Vetsulin

Some problems with curves can be managed by adding carbs or fiber or something that's slow to digest... depends on what the problem is. The curve also would tell us whether the snacks are causing any problems.

WD and NPH are usually a pretty good match. I'm anxious to see how the next curve comes out.

Natalie

[brewerdl]

Re: On NPH vs Vetsulin

Natalie,
Are there directions on the site on how to do a curve?? I"m assuming I need to do a blood sugar reading every couple of hours and note when & what she eats?? I'm not sure a curve has been done on her - - I just try and keep track of her readings and adjust if it starts to go to high or add a snack in the unlikely event it drops too low (it's only been low a couple of times). BTW - - what readings do you use to constitute low? Less than 100? (I use an Accu-check Aviva meter - I understand the readings can be a bit lower on these than what the vets use??)
Thanks!!!!

[CarolW]

Re: On NPH vs Vetsulin

Hi Deborah,

I deeply trust our dogs who are truly our companions make our homes dog-homes. Yes, they belong to the dogs. It's only non-dog humans who call that "spoiling"; we don't have to go along with that definition.

haha

So you have an affinity for Keeshonden. I can see why. They're too big for me to manage now, so I went to Australian Terriers, and have just, with Kumbi's death, ended my 35-year Australian Terrier Era. And Kwali and Kumbi were truly great representatives to have done the final honors.

http://www.coherentdog.org/dogselect.php

So, to your further questions. Yes, I think there's information on doing curves on the main k9diabetes site; I'd go there and read all the articles; they are excellent.

http://www.k9diabetes.com/

You'll find some here as well:

http://www.coherentdog.org/vek/bgcurveprep.php

I'd like to remark here that just taking readings and then adjusting insulin doses based on those can easily leave you up the creek without a paddle. I think that's what people call "chasing numbers."

As Natalie has so often said, what we're looking for, when we do CURVES (every-two-hour readings is common for curves), THOSE give us some data concerning what happens with the combination of food, insulin, exercise, rest, and so forth, that our dogs are having.

Once you have data from several curves, you can begin to see trends, and so get some idea of how all this stuff works together for your dog. It's not until you have those kinds of data that you can really make good estimates about where to tweak what and by how much.

For a journey in curves, mostly from Kumbi, but also from a few other dogs, you can have a look here:

http://www.coherentdog.org/vek/curvejourney.php

In many ways, Kumbi was very consistent. This allowed me to plan. It also allowed me to go quite long periods without testing at all. Kumbi stressed heavily with testing, though he was very cooperative.

He would be clearly very stable for weeks, even months, at a time, and at most during those periods, I'd do a spot-check or a few if I thought something might be going wrong, or if he was too variable, I'd do a curve.

My vets said they do not change insulin doses without having current curve information. Seems to me, that's a good idea.

There's a jiggle on my dog-search line, so I'm off to bed to try to refresh myself, in case something nice happens.

Fri, 13 Aug 2010 21:58:44 (PDT)

[brewerdl]

Re: On NPH vs Vetsulin

Thanks for all the info, Carol!!!! I'm getting ready to leave in a few minutes for a business conference. I have to be gone for a week so Magil will be boarded at the vet's while
I'm gone. When I get back I'm sure I'll have more questions about the curves. AND more time to respond to your note
Thanks again!!!!!

[k9diabetes]

Re: On NPH vs Vetsulin

Basic curve is a prebreakfast reading and then readings at least every 2 hours for as long during the day as you can, a minimum of 12 hours with the last reading done just before dinner.

The great thing about curves is they can identify problems such as blood sugar that is high part of the 12-hour period and low at another part. A spot check wouldn't tell you about large swings in blood sugar.

I like to see the blood sugar no lower on a curve or spot check than 100 (actualy blood sugar, meter readings depend on how accurate your meter is with your dog). That's high normal but it leaves wiggle room because blood sugar isn't like a thermostat... it varies significantly day to day. Using a low of 100 allows for it to vary and still not go too low.

Natalie