Gretel is now our angel

[k9diabetes]

Re: Mini Schnauzer Gretel - Injection problems brewing!

And the pharmacist said to me (you're going to love this) "why would you want them with half unit markings?" To me, the answer to that question should be perfectly obvious - so that you can draw it up by half units if necessary!!! Yikes.

LOL... That's like asking who is buried in Grant's Tomb!

I don't know if Hocks can beat the price you are paying but I used to order syringes direct from them and could choose from a huge selection: www.hocks.com.

Natalie

[CoolGram]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Hi All,

I need help with calculating the correct amount of dogfood to feed Gretel now that she will be eating just the dry rather than canned & dry mixed. The vet has figured it for me, but being the control freak I am, I had to also calculate it myself, and I'm not coming up with the same amount she has.

The point is that Gretel needs to be consuming basically the same amount of total calories per meal that she was before the change.

It's very possible that I'm totally misunderstanding something here, but I checked on the can and bag of w/d and this is how the calories are written:

Canned - 329 kcal/can (I'm assuming that means 329 calories per can, but maybe it doesn't? What does the "k" mean?)

Dry - 243.3 kcal/per cup (Again I'm assuming that it's 243.3 calories per cup.)

Gretel has been getting 1/2 can plus 2/3 cup of dry w/d at each meal.

The vet told me to now give her 1-1/8 cup of dry each meal. When I figure it out, I come up with 1-1/3 cups per meal.

Can anyone out there figure this out and let me know what you come up with? If everyone agrees with me I'll call the vet and let her know she's made an error. But until I know for sure, I don't want to feed her only 1-1/8 cups if it isn't enough to balance the insulin dosage.

Thank you so much!

Carolyn

[Patty]

Re: Mini Schnauzer Gretel - Injection problems brewing!

The vet told me to now give her 1-1/8 cup of dry each meal. When I figure it out, I come up with 1-1/3 cups per meal.

That's what I get too Carolyn. 1.34 cups of dry food per meal which equals 326.7kcal.

Patty

[CoolGram]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Thanks Patty. I know it's been a long time since I went to school but I thought I was still capable of doing a little math! I got the exact same answer you did.

The vet tech was the one who called me to tell me what amount the dr. came up with, and I'm wondering if maybe she misread the 1/3 for 1/8.

Again Patty, thanks for confirming what I felt was the correct answer. Glad I didn't just blindly start feeding the 1-1/8 cups. Goes to show you how it pays to stay on top of things and question, question, question.

Carolyn

[CoolGram]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Well, after a trip to the Wal Mart pharmacy this evening, I'm more confused after coming out then I was when I went in.

I took the box that Gretel's NPH insulin came in because I wanted to ask the pharmacist if the NPH and the Relion N brands were interchangeable. After reading all the posts here about that, I assumed that they were. The clerk at the counter took the box and showed it to the pharmacist and then came back and told me that he said they were not the same. Needless to say, I was very surprised because that's not what I expected to hear.

My vet also was very hesitant to ok the switch. She said she'd have to look into it. So I thought if I went to the pharmacy and they told me it was the same, then I would have that information to give the vet.

Well, it didn't work out that way. Now I'm not sure what to do, because I was really hoping that I could make that switch at some point in time because it really would be less expensive.

On a brighter note, Wal Mart did have the short needle syringes with the half-unit markings, so I didn't come away empty handed.

Does anyone have any thoughts as to why the pharmacist would have told me that? I don't know whether to just let it drop or pursue it further.

Carolyn

[CarolW]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Maybe the pharmacist is going by the label. Might check the package inserts; they should have similar information - maybe even the same information. Or, Carolyn, phone Novo Nordisk Customer Care.

Hehe! THEY will likely tell you the insulin is the same.

I've always read that it's the same. Read that - where? Here and on other forums. And that made sense to me.

Do report back when you have more information!

Glad you got those syringes! Don't forget to check for markings, so if the plunger goes beyond zero, you can either estimate how far off it is, or mark the syringe (I mark the cap) for returning.

I've had a few of these the last few days. Mine are BD syringes; perhaps yours aren't, and they're all right.

Looking forward to your further news!

Fri, 4 Jun 2010 19:58:32 (PDT)

[CoolGram]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Hi Carol,

Thanks for the suggestion - I think I WILL call Novo Nordisk Customer Care.

And, I always do check the syringes to make sure the markings are accurate, but I actually bought the Relion brand this time. I didn't see why it would hurt to use those, and they were only a little over $12.00 per 100.

Well, gotta go. A thunderstorm is in the works and I need to shut this computer down (and go hide under the bed!!)

Will keep you posted,

Carolyn

[Patty]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Carolyn,
Back when Peggy's Forbin was having some sneezing, cold type symptoms after switching I'd looked up the ingredients in Humulin N vs. Novolin N (which is what the Relion insulin is). The primary ingredients are the same:

HUMULIN NPH and HUMULIN 30/70
Each vial or cartridge will contain human insulin (recombinant DNA origin) and the following excipients:
m-cresol distilled 1.6 mg/mL,
glycerol,
phenol 0.65 mg/mL,
protamine sulphate,
dibasic sodium phosphate,
zinc oxide,
water for injections.
Hydrochloric acid and/or sodium hydroxide may have been used during manufacture.
http://www.medsafe.govt.nz/Profs/Dat...Humulininj.htm

NOVO NORDISK PROTAPHANE® Isophane (NPH) insulin suspension injection 100 IU/ml

Excipients
Glycerol
Disodium phosphate dihydrate
Metacresol
Phenol
Zinc chloride
Protamine sulphate
Sodium hydroxide
Hydrochloric acid
Water for injections
http://www.medsafe.govt.nz/Profs/Dat...taphaneinj.htm

My understanding is that the difference lies in the fact that some of the ingredients are from different sources and the base solutions are made using different processes.

Here's the link to Peggy's thread if you want to read through it. http://k9diabetes.com/forum/showthre...Forbin&page=18

There are dogs that respond differently to one or the other insulin. Kevin's Ozzi peaked earlier on Novolin N. But for the majority of dogs that have switched they can be used interchangeably.

I think the cost savings definitely makes it worth trying

Patty

[eileen]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Well, after a trip to the Wal Mart pharmacy this evening, I'm more confused after coming out then I was when I went in.

I took the box that Gretel's NPH insulin came in because I wanted to ask the pharmacist if the NPH and the Relion N brands were interchangeable. After reading all the posts here about that, I assumed that they were. The clerk at the counter took the box and showed it to the pharmacist and then came back and told me that he said they were not the same. Needless to say, I was very surprised because that's not what I expected to hear.

My vet also was very hesitant to ok the switch. She said she'd have to look into it. So I thought if I went to the pharmacy and they told me it was the same, then I would have that information to give the vet.

Well, it didn't work out that way. Now I'm not sure what to do, because I was really hoping that I could make that switch at some point in time because it really would be less expensive.

On a brighter note, Wal Mart did have the short needle syringes with the half-unit markings, so I didn't come away empty handed.

Does anyone have any thoughts as to why the pharmacist would have told me that? I don't know whether to just let it drop or pursue it further.

Carolyn

Oh Carolyn, you'd be surprised at the misinformation I've gotten from a pharmacist at the Walmart pharmacy.

It's very possible that by the pharmacist saying they were not the same he meant the box that you showed him was not the same as ReliOn Novolin N, which it wasn't...that's not to say they are not both NPH insulins.

As I posted previously, my vet too was hesitent when I asked about switching from Humulin N to ReliOn Novolin N, only I think because he had never heard of this particular brand that Walmart sells....I did it anyway, 4 years ago.

ReliOn Novolin N IS NPH insulin made by Novo Nordisk as Humulin N IS NPH insulin made by Eli Lilly.

Altho they are both NPH insulins and most often interchangeable some can notice slight differences. It is best to chose one, stick with it and not go back and forth between the two.

If I were you I'd go directly to the source and call Novo Nordisk...hear it from 'the horses mouth'.

[CoolGram]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Thanks to all who responded. Eileen, your comment about the misinformation you've gotten from pharmacists really hit me. It's scary and very worrisome that there are pharmacists out there who are dispensing incorrect information. There are people (and animals) who are really depending on them to get it right, literally lives depend on it. Until Gretel was diagnosed, I just always assumed the pharmacists knew what they were talking about (you know - right up there with doctors - ha!). Now I know differently and it really scares me. Guess we can never afford to let our guard down, can we?

As I was typing this, I remembered that my husband has a customer who is a pharmacist in another town close by, and I've known him myself since school days (long long time ago ) I'm going to call him with my insulin question too.

Oh Eileen, in case I may have given the impression that I would go back and forth between the 2 insulins, no, I would never do that. I was just hoping that I would be able to make the switch to the Relion brand and stay there.

Carolyn

[eileen]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Thanks to all who responded. Eileen, your comment about the misinformation you've gotten from pharmacists really hit me. It's scary and very worrisome that there are pharmacists out there who are dispensing incorrect information. There are people (and animals) who are really depending on them to get it right, literally lives depend on it. Until Gretel was diagnosed, I just always assumed the pharmacists knew what they were talking about (you know - right up there with doctors - ha!). Now I know differently and it really scares me. Guess we can never afford to let our guard down, can we?

As I was typing this, I remembered that my husband has a customer who is a pharmacist in another town close by, and I've known him myself since school days (long long time ago ) I'm going to call him with my insulin question too.

Oh Eileen, in case I may have given the impression that I would go back and forth between the 2 insulins, no, I would never do that. I was just hoping that I would be able to make the switch to the Relion brand and stay there.

Carolyn

Carolyn,

I would much rather have a pharmacist tell me that he/she simply does not know rather than to pass off bad information.
One basic incident that really stands out in my mind is when a Walmart Pharmacist told me that ReliOn does not make syringes with half unit marks...I told him I've been buying them for years from HIS pharmacy...he got so insistent in telling me that there was no way I did and even went as far as telling me to 'take my business elsewhere'.

When I asked another about the differences between Humalog and Novolog he looked at me blankly and said, " what is Novolog?"

Several years ago a close friend of mine who is a medical doc herself with a diabetic dog encountered a pharmacist that was way off base in what he was telling her, so much so that she reported him for the safety of others.

I was by no means implying that YOU would go back and forth between the two insulins rather just stating a general suggestion based on the wording coming across that the two are interchangeable...didn't want others to think back and forth would be alright.

[CoolGram]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Hello everyone,

Well, I bit the bullet and decided to try again to test Gretel. After much thought (and I do mean MUCH), I decided to try the ear as my next test site. I'm just very uncertain about the lip as I really don't think she'll tolerate that well, not to mention, being a schnauzer, she has a lot of hair around the mouth area.

Anyway, I put her in the kitchen sink as I was home alone and felt it was someplace where she couldn't get away from me. She was quite apprehensive, but I think only because she thought she was going to get a bath (that's where I give it to her).

I warmed the inside of her ear a bit with a warm cloth. I really wasn't sure what setting to use on the lancing device (it's a softclix). I actually stuck her 4 times, starting out on setting 2 on the dial, working my way up to 4. I was very pleased that she didn't move or flinch - HOWEVER, I never did get a drop of blood. I felt four stabs was quite enough to subject her to, so I'll try again in a day or so.

I'd love to know what setting any of you use who are testing on the ear. I certainly thought 4 would be plenty high enough, but apparently not. Guess the only thing I can do is work my way slowly up the dial till I get blood.

Just wanted you know that even though I've been quite wimpy about doing it, I haven't given up yet.

Oh, and her last curve (Monday of this week) was 205 at 9:00am (2 hrs. after eating and insulin), 236 at noon, and 346 at 3:00pm. The vet bumped her up from 13-1/2 units to 14 and will do another curve in one month. The reason I'd really like to begin testing is because we're working to get her triglycerides down and if they get low enough she may require less insulin, and a month is a long time to wait for another test, even though I know the vet would spot test before the curve if I requested it. But at least that much I'd like to be able to do myself.

Carolyn









Carolyn

[Ladybug]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Hi Carolyn,

I'm just very uncertain about the lip as I really don't think she'll tolerate that well, not to mention, being a schnauzer, she has a lot of hair around the mouth area.

I thought that about Ladybug from the very beginning....no way Jose on the lip area! She also has a lot of hair in the lip area. But, you fold back the lip and prick on the inside of the lip, not the outside. There are no nerves there so there is no pain or discomfort for the dog. I started with the ear, went to the paw pad and finally went to the lip and finally found my success with the lip area. Blood every time on the first prick!

I may be wrong, but I think that the blood that you get from the ear is venous blood which doesn't work very well with home testing meters. These meters are to be used with capilliary blood. I'm sure someone will come along and correct me!

Good luck!

Linda/Ladybug

[CoolGram]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Thanks for your response Linda. I will probably decide to give the lip a try eventually. Just knowing Gretel as I do, I just haven't thought that she would be very accepting of me messing around her mouth. Of course I didn't think she'd let me do it on her ear either, and she did.

I tried not to be nervous, but I was - couldn't help it. This was my second attempt at testing and the first time wasn't any better - in fact it was worse. I used the lancet alone and tried to stick her in her dew claw pad and I couldnt draw blood there either but I'm sure I was being timid about pricking her and probably didn't do it quite hard enough, but I didn't want to hurt her and she was acting like it did hurt.

With a diabetic dog you find out there are a lot of things you can do that you wouldn't have thought possible. I'll keep trying!

Carolyn

[Ladybug]

Re: Mini Schnauzer Gretel - Injection problems brewing!

Hi Carolyn,

Everyone here says to breathe normal....don't hold your breath. If you are tense and hold you breath, Gretel will know and that will tense her up also.

I was an absolute mess when I was first attempting to test! But now, I always talk to Ladybug the whole time we are testing. Sometimes I even sing....just hum some notes, not any specific song, whatever comes into my head! Trust me, I can't carry a tune, but it works! She relaxes and so do I!

You will make it and then all the members will welcome you to the "Vampire Club"!

Linda/Ladybug