Varying Insulin Requirements

[pgcor]

I've been wrestling with a question for awhile and have been reading up on this topic. I thought I would run this past some of you......

It's sort of multi-layered, but once a dog has been regulated and given there are no other "major" factors affecting blood sugar - and food and exercise remain relatively the same:

1. How much insulin wobbling is considered "approximately" normal? For example, would you be alarmed at a 1 unit drop or increase occasionaly throughout the year?

2. Is a drop in insulin needs never acceptable, but increases are to be expected?

I know that dogs are not machines and that insulin requirements change. I'm just trying to wrap my head around basic assumptions - if you know what I mean?

I realize that throughout the day blood sugar goes up and down and changing insulin everyday based on individual blood sugar tests is not recommended nor required. I'm just curious if there is a "normal" range that can be considered normal wobbling.

I have a feeling I'm not explaining myself very well here...sorry if that's the case.

[jesse girl]

Re: Varying Insulin Requirements

for jesse we have reached a point where we can have pretty tight regulation just a few months ago I did not think this was possible

I will make very small adjustments in insulin dosing up or down depending on the numbers at the time but not to much any more

she may receive a snack, type or amount may depend on her numbers and I am seemingly relying on this method than insulin adjustments lately

under conditions where she had a wobble or just running high for whatever reason I will use micro doses of fast acting to bring her back into good numbers once again not used to much

generally for jesse her dosing has stayed constant for awhile but change will happen as they get older and being flexible and willing to adapt to new circumstances will be a big help . she has been so tough to regulate so being flexible is her middle name

I think there is no set normal way its what ever works for your friend and you that keeps them happy and safe

[pgcor]

Re: Varying Insulin Requirements

Hi Jessegirl - I'm glad you answered, so maybe I can better clarify what I'm trying to get at...

My curiosity in this regard is not based on my dog's individual requirements; I'm curious at what point and after how many bg tests people consider tweaking insulin. I just heard about someone who tests her dog several times per day and adjusts insulin (very slightly) based on his need that day.

I'm just wondering how normal it is to tweak insulin (up or down) and then return to the normal dose in a regulated dog.

I know human beings do this more often that it seems we do for canines - probably because we have such tight control on their food intake.

Now that you've achieved regulation with Jesse would you consider tweaking insulin to deal with minor fluctuations in bg? (testing everyday and increasing or decreasing by a 1/4 unit). I've often wondered if that is what folks meant be tight regulation? And is this okay to do?

[jesse girl]

Re: Varying Insulin Requirements

that is a very good question

you can have 2 extremes to the question I know a dog who is not home tested goes to the vet once a year to do a curve make adjustments and call it good they all seem happy and healthy then you got my jesse I test her 5 times a day and 3 shots dont do curves anymore maybe spot check out of the 5 time i test and call it good and she is happy and healthy

she seems to do much better with tight regulation 100 point up or down plays havoc with her system and she doesnt tolerate the the mid 200s very well anymore maybe from being better regulated

are goal is to keep her constant in a tight range low to mid 100s and yes we would use varying amounts of insulin to get there but very small adjustments up or down

I may treat her like a humane type routine to a small degree with adjustments with insulin and also food to get that tight regulation depending on her numbers before food and shot. even small snacks have worked wonders I have went on humane sites before for an understanding of how its approached I think most would not want to put this kind of time in there dog and people outside of this world think its kind of strange doing all those things to your dog they seem a little dumbfounded for me its all or nothing

I think there bodies dont like bouncing around with jesse she will get a response from her body by dumping sugar so tight is better for her more work of coarse but well worth it

[k9diabetes]

Re: Varying Insulin Requirements

Chris' dose wandered between 6.0 units and 8.0 units and I adjusted it in quarter unit increments. (I had thought it was more like 7 units but in looking at the actual log, I see it was often more like 6 units.)

For me to have stuck with the same dose every day, I would have had to give as little as 6 units and had many days when his blood sugar ran higher.

I didn't technically use a sliding scale as after a lot of testing I knew Chris' pattern and how he was likely to respond.

I maintained what I would consider to be tight regulation - I aimed to keep his blood sugar under 200 all of the time. I didn't always succeed certainly.

People use basal and bolus insulins and generally rarely adjust the basal dose once they determine one that works for them. They adjust the bolus insulin only on a daily or weekly basis. With dogs, we are giving the basal and bolus doses with the same insulin so it's tricky to adjust it.

I have no problem with sliding scales that are for minor variations in the insulin IF it's clear that each injection is lasting no more than 12 hours. If there is the possibility of overlaps, then varying the insulin amount can make things really crazy.

Sliding scales can be a really good solution for dogs whose blood sugar is very inconsistent day to day when the insulin dose doesn't change. It allows you to get better regulation long-term instead of giving the dose that works for them on low days and letting them run higher the rest of the time. But it's an advanced technique based on a lot of testing to establish a pattern and to sort out a sliding scale that works well.

I'm attaching a sample page of Chris' log. Apparently this was the time when I was doing a comparison of the OneTouch and the AlphaTrak. Ignore the Fstyle heading at the top. That column was just a record of my "adjustment" of the OneTouch Ultra reading.

Natalie

[CarolW]

Re: Varying Insulin Requirements

Hi Pam - good to be hearing from you!

Here, I'm going by memory and instinct. Remember I'm now out of practice! But I think I can feel pretty well what I'd be doing about BG variations.

I'd be keeping an eye on them with spot-checks, and NOT making tiny adjustments, day-to-day, as I feel that could kind of confuse the dog's body! That is, there WILL be BG variations, day-to-day, at least some of which, you'd likely be at a loss to explain. I know Kumbi had such variations.

Sometimes I thought Kumbi's variations were seasonal - changing as the basic weather patterns changed; others tended to say their dogs responded similarly to seasonal changes in weather. I was using Novolin-NPH; nothing else. I'd adjust up or down, usually by a quarter-unit - rarely, half a unit - and hold the dose there for at least a week; then I'd do a curve. That worked out well for us.

In his last six months or so, Kumbi's situation was complicated by his cancer - we didn't know it was that at the time. Still, I held his insulin doses as steady as before.

I think of you, Pip and Newman often! Do keep us posted!

Hugs, licks and wags,
Tue, 19 Apr 2011 10:56:12 (PDT)

[pgcor]

Re: Varying Insulin Requirements

Yes! Thank you all. Natalie, is a basal/bolus insulin combo most often used when treating on a sliding scale? - as opposed to NPH?

Please correct me if I'm wrong, but didn't Chris have other health issues (in the beginning of his diagnosis with diabetes) that might have caused more erratic blood sugar than a dog with no underlying issues? Or is it a rarity to find a dog with diabetes and no other underlying issues? It's hard to tell from our web site because we're such a small group in comparison to the larger population. I tend to think that folks that come here seem to have issues from the get-go. Would you agree with that?

I don't want to be a PITA, but I find the more I read, the more fascinated I become with treatment options for diabetic animals.

Seeing your diligence on paper in treating Chris is unbelievable! Again, I'm going to need you sometime in the future at my bedside!

Whenever I try to apply a more global approach, the more I see how individualized treatment options have to be for our dogs, and really for us as well. I think I'm going to have to give this thought process up.

Hi Carol - have been working diligently at curbing our reactionary behavior and am constantly amazed at how effective this is! Even with the humans (aka husband) in the house!

I have learned so much about my dogs and my own strengths and weaknesses since Pip was diagnosed with diabetes that on a few occasions it almost seems like a blessing. I've italicized "ALMOST", I don't want to go too far!

[jesse girl]

Re: Varying Insulin Requirements

It is like a blessing for me my eyes were open and I could see I did not know how much I cared about my little girl and how we both needed to change are lives for the better



By improving jesses health I followed her and improved mine who knows she may have saved my life and maybe thats the way it was intended for both of us

[CarolW]

Re: Varying Insulin Requirements

Pam - if there's anything different about members here, perhaps it's first a bit of luck for those here that they found us (Natalie, Patty and Peggy); then the rest of us learn from them- and second, that those who come and stay willingly dedicate very large parts of their lives to their (diabetic - and other) dogs.

That is, people here are paying attention ;-)

I'm SO thrilled at your progress with Pip and Newman! I think men find it more difficult than women to adapt when dogs start to show over-reactivity, and I commend your husband for making progress. I gotta say, Camellia's DogDaddy George breaks many of the calming signal rules; primarily; he hugs Camellia a lot, in ways that would greatly distress a totally over-reactive dog. But he's a great DogDaddy, and Camellia adores him, and is all over him! I just sent a bunch of pics to the woman from whom I got Camellia; mostly with George and Camellia; one with Camellia in her crate (she's not once been SHUT in her crate).

The woman was thrilled. And they're nice pictures, but I'm too tired to post them on Coherent Dog.

Someday, I should. They make a nice series.

Above all, though, I think diabetic dogs can really enjoy and work with their Human Dog-Parents well when the humans learn of the calming signals, and use them. There ARE dogs whose genetic and early experiences prevent them from relaxing well, but those are relatively few; most can, with assistance, learn to relax at least for injections, and many, for BG-testing as well.

Pip may not be one of the latter!

Anyway, keep up the good work, Pam. So glad you're enjoying both dogs; they grace my screen frequently!

Tue, 19 Apr 2011 12:31:38 (PDT)

[eileen]

Re: Varying Insulin Requirements

Pam,

As Natalie I do not use a sliding scale with Mildred but have always tested every fasting as well as 2+ more times a day, every day, so do make minor insulin adjustments based on these readings.

I know Mildred so well that I can make these adjustments based on how I know she will respond.

I'm not currently using the Humalog/NPH combination but for the period in time when I did I kept her basal dose the same and adjusted her bolus.

I think there are a variety of reasons people seek out groups such as this. Some such as myself from the get-go simply because I knew nothing about diabetes in a dog so wanted to learn everything that I could.
I've been an active participant in a number of groups for 6 1/2 years, constantly learning with also turning what I have learned around and passing it on to others.

[jesse girl]

Re: Varying Insulin Requirements

natalies detail is just incredible this may appear to be complicated and out of most peoples league but it doesnt have to be if you have the desire you can do most anything and it proves wright there even a dog like criss with all his problems was regulated very well with a very ingenious program

for us I dont have that scientific detail wish i did but i dont most things for me flow better in my head than on paper I kept a log for such a long time and for me it made things harder maybe i am a little dyslexic

It seems i am very in tune with jesse and I understand her very well to usually no how to adjust I probably could not do it for any other dog but her maybe its all the time but we seem to have a symbionic relationship together

the point i am making is better regulation can be accomplished in any dog and there is always hope you do not have to be a genius to accomplish this just a desire to want to help your fury freind

[pgcor]

Re: Varying Insulin Requirements

I'm glad I posted this question, very interesting information. Thanks all of you for sharing!

[k9diabetes]

Re: Varying Insulin Requirements

I will write more later but wanted to add that we had something of an advantage in that we were already using faster acting insulin only on a short schedule of every six hours. So for us to "correct" blood sugar with faster acting insulin we could only adjust the insulin he was using for everything.

Natalie

[k9diabetes]

Re: Varying Insulin Requirements

For anyone interested in some pretty serious detail about managing blood sugar in people, John Walsh's book Using Insulin is a good resource. Pretty intense if you try to absorb every detail (after reviewing it, I was glad I was dealing with a diabetic dog as being a human diabetic, at least before there were insulin pumps, sounded absolutely exhausting!) but you can pull out the core concepts, which can be helpful when tailoring a plan specifically for your dog.

The insulin you choose to adjust depends on when the problem occurs and the action times of your insulins. . . . Be conservative when you change your insulin doses unless there is a clear reason to do otherwise. With basal insulin, change one dose by one or two units at a time and wait a few days to see what effect this change has before making another one. If you are sensitive to insulin, you may want to adjust by even less than one unit. Change one dose at a time because when more than one dose is changed and an improvement occurs, it becomes difficult to see which correction may have caused the improvement . . . If you go on a diet and suddenly reduce your caloric intake and lose weight, you may need to reduce all your insulin doses [basal and bolus] (page 181)

And the title of a whole chapter, which are words I live by when trying to figure out a blood sugar problem...

Patterns - Correct Low Blood Sugars First (page 183)

Basal needs don't change often. It takes something like weight loss, thyroid levels... things that would affect the metabolism, absorption, etc. So the basal dose doesn't need to change often.

Natalie

[k9diabetes]

Re: Varying Insulin Requirements

Dogs rarely get basal (intermediate or long acting insulins) and bolus (fast acting insulins to cover meals) insulin doses because most of the time they don't need a bolus insulin. They often process intermediate-acting insulins like NPH and Vetsulin/Caninsulin in such a way that there is no post-meal food spike. In fact, sometimes they process these insulins so quickly that they actually get very sharp drops in blood sugar after injection instead. This is especially true with the prescription diets, which are meant to be digested slowly and provide a moderate supply of glucose over a fairly long period of time.

So a diabetic person would be taking a longer acting insulin (once NPH would have been somewhat common but now mainly Lantus and Levemir) for their non-meal basal needs and a fast or faster acting insulin (Novalog, Humalog, Regular) for their meal-related bolus needs.

Chris was very unusual in that he used faster acting insulin only. I had never heard of anyone who did this prior to a teaching hospital endocrinologist suggesting it as an option. We were able to manage more injections a day, which is one reason it's rarely tried.

We started with meals and a shot of Regular insulin three times a day, every 8 hours - a worse schedule than every six hours in my opinion! Since we did that for quite a while with a lot of testing, I was 100% certain that Chris never ever got more than about 6 hours from Regular because I could see from all my testing that his blood sugar started rising sharply at the 6 hour point. So I wasn't worried about overlapping injections of different amounts of insulin from one injection to the next. He also got a rise in blood sugar in the first couple of hours after a meal. So even if there was a teeny bit of overlap, it wouldn't cause lows.

That's where you can get into trouble by often changing the dose of any insulin. If doses start overlapping, the blood sugar can start a rollercoaster ride.

Essentially, we had to make an artifical partition between about half of his dose going to basal and half to his meal-generated glucose and it was the meal-generated half that we adjusted.

Natalie