Insulin doses

[Tracy]

I am looking for a general idea on average insulin doses related to a dog's weight. We have an around 80 lb shepherd/collie mix that we have been trying to regulate for about 2 months now. We are currently at 19 units of insulin twice a day and his glucose numbers are still relatively high. I am just curious about dose amounts and weights, are we close to averages, are we giving too little or too much? Any numbers would be appreciated to get an idea of where we're at. Thanks

[k9diabetes]

Re: Insulin doses

Hi Tracy,

In response to a similar question, I gathered some historical data from two different forums, which you can look at here: http://www.k9diabetes.com/forum/showthread.php?t=1651

In general, I'd say the average dose for a diabetic dog is between 1/4 and 1/2 unit per pound.

A dog isn't considered insulin resistant until she is on 1 unit per pound and still the blood sugar is very high.

So, as you can see, your dog's dose is still on the low side at just under 1/4 unit per pound. Many dogs are started at that dose on day one.

Unfortunately, we sometimes see veterinarians who believe that basically no dog should need more than 20 units, no matter how large they are and have refused to increase the insulin dose.

Marie's Bruno (http://www.k9diabetes.com/forum/showthread.php?t=1617) had one of those vets. He was keeping 90 pound Bruno on 12-15 units of insulin and Bruno's blood sugar was in the 600s.

Now that Marie found better veterinary advice and the dose has been raised to 30 units, he is seeing his blood sugar finally come down. 20 units for him was like injecting water! I suspect Bruno might need around 35 units.

There's a ton of variation. Two terriers I know weighed around 25 pounds each and need 20-22 units of insulin per injection. That is unusual. But their blood sugars were perfectly regulated on that amount. They needed more than average.

How high is your dog's blood sugar?

Please tell us more!

Natalie

[CraigM]

Re: Insulin doses

Hi Tracy,
Just wanted to say "Hi" and welcome. My Annie only weighs 17 pounds and is doing well on 8 - 8¼iu of NPH twice per day. Of course, each dog will have it's own requirements. What insulin are you using? Tell us all about your dog, and if you are doing home blood glucose testing.

Craig & Annie

[ozzi]

Re: Insulin doses

Hi Tracy,
I noticed that your dog has been treated for diabetes for two months. I'm curious how his/her blood sugars are now. Also, what type of insulin are you using? Ozzi, who weighed 67# at diagnosis was started on 15 units Novolin N twice/day, and although there was an immediate marked improvement in his behavior, urine ketones and blood sugars, he still had high sugars for several months while I adjusted him up to 24 units twice/day. He seemed to stabilize and his sugars were fairly good but not perfect. He went from just over 600 at diagnosis to below 300 most of the day. My vet was happy with those numbers and wasn't as aggressive about lowering it any more than that. About three weeks ago, he started having fasting BG's in the high 500's and I made a few changes. I started adjusting him from square one. He is currently on 21 units Humulin N in am and 19 units Humulin N in pm. He is still having morning fasting BG's in the low 400's and tonight his pre-injection BG was 204 so I lowered his evening dose to 17 units. I'm increasing his evening dose slowly out of fear, since I can't watch him while I'm sleeping!! And that's why I decreased it tonight given that his BG was just over 200. I think he'll end up around 21 units in am and 20 units in pm.

As Natalie pointed out, a lot of dogs start at about 1/4 unit/pound twice/day. I'm wondering where you started two months ago, because 19 units twice/day seems like a "starting" dose, and he'll probably need to be increased if BG's are still high. I don't know the average time it takes to get a dog regulated on insulin, and that's an interesting question, but I can tell you that I'm still struggling with Ozzi after 7 months.

Kevin

[peggy0]

Re: Insulin doses

Just for a reference, my 90 pounder gets 23 2x a day welcome to the board. You'll learn alot here and make some friends as well

[Noodle]

Re: Insulin doses

My dog Noodle was started on only 8 units and weighted over 60lbs at diagnosis. He now hovers in the low 50's and needs 30 units for good regulation, so you can see that it can vary a lot.

Welcome to the board!

[CoolGram]

Re: Insulin doses

Hi Tracy,

I'm new to this board also. My miniature schnauzer, Gretel, was diagnosed toward the end of January and we're still struggling with the right dosage. She currently weighs 19 lbs. and is getting 10 units of NPH twice a day. Her last spot check was 5 days ago and her BG was still 383. So ours is an ongoing situation, not sure what dosage she'll finally end up on. She is feeling better though. More energy, not drinking heavily, very playful. The vet assures me we're going in the right direction, just very slowly.

You have really come to the right place for support. I don't know what I would have done without everyone here giving me such good advice and encouragement. Good luck to you and your dog.

Carolyn

[Tracy]

Re: Insulin doses

Thanks everyone for sharing your information. Our dog Schultz is an almost 10 yr old Shepherd/Collie mix that weighs around 80lbs. He has been getting the Novolin type insulin since around the beginning of this year. We started with 10 units 2x a day and have been gradually increasing by 1 unit per dose each week since. We just bumped it up to 20 units 2x a day this week. His blood glucose values have generally been between 350 and 450 during home blood glucose testing. I think the lowest reading he's had was 157 and the highest was > than 500 (off the meter). Our biggest issue with the testing is his numbers seem to have no real consistancy. Sometimes they're good, in the 200s, then other times they're high, in the 400s, for seemingly no reason. He gets the same amount of Hills Science Diet W/D 2x a day and no longer gets treats throughout the day. The only other variable in the mix is that he is on Phenobarbital for control of seizures that he started having in August 2009. Our vet said more than likely that the Phenobarb is what led to the development of his diabetes, even though it is controlling the seizures.

[CraigM]

Re: Insulin doses

Hi Tracy,

Wonder where you get your Novolin? Are you aware that Wal-Mart sells Novolin under their ReliOn branding? You might save a few $$ there.

Sounds like you are increasing the dosage, and getting better results. It does take awhile to make the adjustments! Just go slow as you have been and I would try to get the lowest reading during the day into the low 100s. You are correct that they can keep us guessing! Annie can be 100 - 250 for days at a time, but then through me a 400 or 70!

What meter are you using?

Craig & Annie

[k9diabetes]

Re: Insulin doses

Have you done a curve recently? If you have, please post the curve results and how many units of insulin it was on as that would give us an idea of how his food/insulin balance is...

Could be that he has large swings in blood sugar so even though it's high sometimes, it's also on the low side at certain times of the day and a little wobble can push him over into rebound.

Some dogs just wobble on their own and an amount of insulin that's fine for a week or so out of the blue is too much or too little.

I believe that some seizure meds interfere with blood sugar or insulin... I have to go look it up and will write another note when I know what I'm talking about!

Natalie

[k9diabetes]

Re: Insulin doses

Well, for one, phenobarbital changes how corticosteroids are metabolized and there is a direct link between levels of cortisol and blood sugar. High cortisol = high blood sugar.

http://www.rxlist.com/phenobarbital-drug.htm

2. Corticosteroids: Phenobarbital appears to enhance the metabolism of exogenous corticosteroids probably through the induction of hepatic microsomal enzymes. Patients stabilized on corticosteroid therapy may require dosage adjustments if phenobarbital is added to or withdrawn from their dosage regimen.

8. Estradiol, estrone, progesterone and other steroidal hormones: Pretreatment with or concurrent administration of phenobarbital may decrease the effect of estradiol by increasing its metabolism.

[Tracy]

Re: Insulin doses

We get the Novolin at Costco, and the anticipated costs of the necessary insulin in the long run may become a concern, but we do what we do to take care of our pets. We use the Bayer Contour meter, as recommended by our vet. We do have a concern whether we should get an animal specific meter, but the vet said they are not any different from what we are using just more expensive. I've read online that you shouldn't use the human type meters because of differences in human and canine blood cells, so I don't know. We often wonder if the numbers vary so much because of the meter.

[CraigM]

Re: Insulin doses

Tracy,
I'm using the AlphaTrak (dog / cat meter). I was given the meter and don't think I would have spent the money to buy it. I think most use a human style meter, and just run some comparisons between their meter and what gets reported at the vets clinic. Just do your test while in the vets office at the same time they take their sample / reading. I believe most say the human meters read about 30 points high, which might just be a nice safety margin!

The things I'd look for in a meter is the cost of test strips and the size of sample required.

Craig & Annie

[eileen]

Re: Insulin doses

I use the Alpha Trak now but have also used several varieties of human meters in past years.
Altho I was able to watch the trends when using a human meter I much prefer the Alpha Trak now.
I've done test comparisons with my AT meter while at the vet and always fall into a very close range.

I've used the Ascensia Contour which I found to be off as much as 130 points so tossed it aside.
I then moved on to the Accu Chek Aviva which I liked much better as well as the Freestyle Lite.

Despite the expensive strips that the Alpha Trak requires I feel much more confident in continuing to use it for Mildred.

I believe there is a posted link somewhere here that shows the results of meter comparisons run by U C Davis.

Eileen/Mil

[k9diabetes]

Re: Insulin doses

We had an AlphaTrak but never used it precisely because it was just so much more expensive and we tested three to four times a day (Chris got four injections a day).

I had done quite a few comparisons of my OneTouch Ultra, which tends to be a really good meter for medium to larger dogs, with lab values and knew it was a pretty consistent 30-40 points low. It was actually closer to lab values at lower and higher numbers.

OneTouch is one that UC Davis recommended in its testing:

ACVIM 2008 Abstract

Evaluation of Six Portable Blood Glucose Meters in Dogs.
T. Cohen, R. Nelson, P. Kass, E. Feldman
School of Veterinary Medicine, University of California, Davis

The purpose of this study was to evaluate six portable blood glucose meters (PBGMs) - AlphaTrak, OneTouch, Elite XL, AccuChek, Precision, Contour - for use in dogs. One hundred fifty-eight venous blood samples were asayed for glucose using all PBGMs in randomized order and by a reference hexokinase method. Results from the PBGMs and reference hexokinase method (HM) were compared.

HM blood glucose concentrations ranged from 41 to 639 mg/dl. There was excellent correlation between PBGMs and HM results (table). Results were consistently low for 4 PBGMs compared with HM results. High and low results were common with the AlphaTrak. The difference in results between PBGMs and HM increased as blood glucose concentrations increased. Difference in results between PBGM and HM were significantly (p<0.0001) less for the AlphaTrak and OneTouch and significantly (p<0.01) higher for the Contour compared with other PBGMs. Problems with correct identification of hypoglycemia (<70 mg/dl), normoglycemia (70-120 mg/dl), and hyperglycemia (>200 mg/dl) varied between PBGMs (table).

Percent Incorrect from Reference Range
AlphaTrak -- 18
OneTouch -- 21
EliteXL -- 45
AccuChek -- 45
Precision -- 49
Contour -- 73

Results of this study support use of the AlphaTrak and OneTouch glucose meters based on significantly closer results with HM.

Their study showed the AlphaTrak and the OneTouch as almost the same degree of accuracy and we have at least one member whose AlphaTrak is no more accurate than her meter for people.

The other reason human meters work really well is that you generally do not need to know if the blood sugar is 220 or 260. Your decisions about insulin would be the same either way. Similarly, it's irrelevant if it's 400 or 450; you know the blood sugar is too high.

I absolutely loved the OneTouch - not only for the accuracy but because you can actually see the strip where the blood fills so you knew it was filled properly and the meter tended to error out when filled improperly rather than give an off reading.

Natalie