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Insulin Kinds of insulin, action profiles, use in dogs, where to buy, etc.

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Old 12-31-2008, 10:39 AM
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Default Using R along with NPH

Just a quick question. Is it advisable to use R when you test daily and see for example a bg of 400 at fasting.? Should R be used to tweek the bg numbers? I have been seeing a lot of R being used with NPH. Can organ damage take place if the Bgs are high at one time of the day? At A & M they only use R during ketoacidosis? I had asked Dr B about this Of course there are other opinions on this matter. I know that you used R on Chris. What is your take on this? Also where the heck has Kathy been You hoo!!!! Kathy Can you hear me?
Marianne
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Marianne and canines: Jasmine( diabetic since 4/10) Puma,Harley,Sebastian,Sophie and cats: Yoda,Sabrina and Cleo. Also Baby Boy (my cockatiel) & Angel Pebbles
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Old 12-31-2008, 12:45 PM
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Default Re: Using R along with NPH

Hi Marianne,

We've all had our turn at getting sick around here. Mine came last.

I know you're gonna start banging your head against the monitor when I say this, but it depends.

It depends on whether there's something else going on, such as an infection which may be causing this. In that case, you need to get that discovered and treated. If there is one, it can be the case for high bg's--it can also bring bg's lower than normal too--just as when you're sick you might be running a fever or you might be running a below normal temp. Either of them can be a sign of an infection.

People and animals with diabetes are prone to developing infections more so than those who don't have it. They tend to be things like UTIs and resps, for the most part. A lot of times these infections are subclinical or hidden, meaning you don't find a lot of evidence that they are there when you do tests--very true especially when it comes to UTIs. Many times, the only way to find the UTI and learn what antibiotic to give to get rid of it is learned by doing a culture. Sometimes the only hint they give you that there's something wrong is bg's that are too high or too low.

If there's no infection, there are possibilities that you can do some food tweaking to get rid of the higher bg's and you remember how you used to bring them down for Pebbles by taking her for a walk, since Dr. B. didn't believe in using R except for keto cases. Some doctors are very much against this and some aren't. I think some of it stems from a fear they may have that the used of some R will cause the animal to go hypo.

People on the other hand are told to use the fast or rapid acting insulins more liberally. They sometimes need to use them for "sick days" to bring down higher than normal bg's and if the person didn't calculate the fast or rapid acting used to cover meals correctly (he/she ate more than planned on), then people use some R as "corrective" insulin to get their bg's back in line again.

When you see R and NPH mixes like 70/30 and 50/50, the insulin is a pre-mix of R and NPH. 70/30 is 70% NPH and 30% R--50/50 is half NPH and half R. Not many animals need that much R as a rule, so when R is called for, it is usually much less than that.

If someone with diabetes needs to use cortisone-type meds for any reason, those can drive the bg's up and then there are times when some R is used to keep the bg's down while you're using the medication.

Organ damage can take place when you go high and stay there for a length of time. While we'd all like not to see any high bg's, going high and then coming back down within a reasonable period of time shouldn't affect anything. When the renal threshhold of 180 has been exceeded and the bg's have stayed there for a while are you going to get a positive reaction with the strips, because until that point, the glucose doesn't spill into the urine.

If someone's needing to use R, I believe you need to be blood testing and you need to be doing it more frequently than you might if there's no R in the picture. R works fast because there's no suspension to it. It leaves the system quickly because there's no suspension to it, but making a mistake with R can easily lead to a hypo incident.

Back in the old days when insulin was first isolated for use in controlling diabetes, R insulin was all there was. There were no suspended insulins until Hagedorn came up with PZI in 1936. Until then, if you needed to use insulin, you had to make sure you set an alarm to wake you up for a middle of the night shot. So the real diabetes pioneers used R all the time, each and every day for their total bg control.

This help any?

Kathy


Take a look at the time action profiles--the one for Humulin R, the one for NPH without any R added, and then look at the Humulin 70/30 which is 70% NPH and 30% R, then the Humulin 50/50 which is half NPH and half R. You'll see the type of "punch" R can pack when you compare that action profile to NPH alone.
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Old 12-31-2008, 01:44 PM
Ginny Dudek Ginny Dudek is offline
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Default Re: Using R along with NPH

I would use R only if my dog snuck some food/treat, and had a high sugar. If the curve is off because of too much or too little N, the dose of N needs to be adjusted.
Ginny
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Old 12-31-2008, 02:44 PM
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Default Re: Using R along with NPH

Kathy skillfully covered most of the bases, as always.

I wanted to add that as a "correction" faster acting insulin like Regular is preferred over more NPH. Since it doesn't last long, it brings a high glucose level down without sticking around to depress the blood glucose too much later on.

It is sometimes used, too, if a dog tends to put NPH to work rather slowly so gets a large spike in glucose from a meal. The Regular can tackle that spike and level things out.

I have seen a few dogs who were said to be extremely sensitive to Regular... like any insulin I believe in trying it very very cautiously and in teeny tiny quantities until it's clear what it's going to do.

Oddly, Chris got a post-meal spike in blood sugar even though he used Regular only!

The vet who suggested we try Regular only did not seem to be afraid of using it - he said that it doesn't get suggested because so few people would be willing or able to give three injections a day. But I have no doubt that some dogs would put the insulin to work far too quickly to use Regular only or even to use much Regular insulin.

Still, I knew another dog who went on the same regimen Chris did (also a large dog, Treu, a rottweiler) and did extremely well with four injections of Regular a day. On Vetsulin she had problems with a highly variable response, possibly from overlaps.

I've been corresponding recently with Andy's mom and suggesting that for now she just ignore the very high premeal BG level since Andy spends most of the day at good numbers, at least until the doxycycline is done and he's feeling better again. His type of curve, with just a few hours a day at high BG levels, is not something that would worry me if that's the best he can do. I was concerned that the NPH and the Regular might double up at about 5 hours, causing him to drop too far if she used R with him. I'm not opposed to trying it - might be just what he needs. But things with him are so unsettled right now that I don't think she can rely on any experimenting done now as indicative of how the Regular will work long term.

One of the things I suggested to her was that if she wanted to give some R, I wouldn't give it with the NPH. I'd give it a couple of hours earlier to handle the apparent failure of NPH to last 12 hours. You can for example, do a 10 - 10 - 4 schedule with two injections of NPH 10 hours apart and then one in early evening of Regular to cover the 4-hour gap, potentially leveling out Andy's curve quite nicely.

Have you seen the dog on the Cushings board getting NPH four times a day?

I'm curious to see what caused them to go to that schedule.

Natalie
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Old 12-31-2008, 04:42 PM
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Default Re: Using R along with NPH

Yes I have questioned that She hasn't responded. Thanks Kathy and Natalie
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Old 12-31-2008, 05:46 PM
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Default Re: Using R along with NPH

This is one ? i am gonna ask my vet, Niki needs to gain weigh i want 5 lbs on her, the yogurt ain't doing it, I asked the vet yesterday what I could add to food, she said she'd get back to me, we can't add oil or butter or anything like that, Niki had low AML in blood back in Nov which is good no signs of pancreatis.

But I cannot give her a big portion of food like a large dog, that would mean more insulin.

all I can think of is asking vet about using some R not for now, but if I want to add some higher carb to her diet, like a 1/2 of a potatoe etc. Wouldn't the R help with something like that, as Niki gets the big rise after a meal and then we have to wait till BG goes down.
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Old 12-31-2008, 06:03 PM
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Default Re: Using R along with NPH

Dolly,

People with diabetes use fast or rapid acting insulins like R to cover what they eat. They use insulins like NPH to take care of their body's basic need for insulin, minus the food they eat.

People determine how many calories and/or carbs is in the meal they are about to have and then use the proper amount of fast or rapid acting insulin that will take care of the meal. We would have a hard time giving fast or rapid acting insulin before an animal eats because of the safety factor. Know that people with small children who have diabetes can have problems when the child won't eat the meal or eats only a portion of it; then they need to get enough of something into the child to "cover" the meal insulin.

If you and your vet determine that some R might work out for Niki, you would, of course, be giving it to her after she's eaten. If you do start giving Niki some R, you might find that you may need to use less units of NPH for her, because the R would be doing some of the work the NPH now is handling totally.

Asking doesn't do any harm!

Kathy
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Old 12-31-2008, 06:13 PM
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Default Re: Using R along with NPH

Yes you are right about the R and NPH needing less, but it does make sense doesn't it if i want to feed a higher carb that R would help, cause Niki's BG would be really high if she ate 1/2 potatoe with her reg meal.

and with just the NPH her BG would stay very high with addition of potatoe with normal food

Oh Wise One, Happy New Year !!!
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Dolly & Niki passed 2010, 45 lb Border Collie Mix 8 yrs as diabetic, 13yrs old. Blind N 10.5 U 2 X * Dog is God spelled backwards*If there are no dogs in Heaven then when I die I want to go where they went. Niki's food Orijen & Turkey & Gr. Beans, See you at the bridge my beloved & cherished Niki, I miss you everyday
  #9  
Old 12-31-2008, 06:46 PM
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Default Re: Using R along with NPH

You bet, because people with diabetes don't spend their lives eating roots and berries.

Some can have things like potatoes, pasta and rice in moderation and sometimes with a little extra help from their fast or rapid acting insulin friend.

All of the people with diabetes don't stay on the "wagon" and never let anything containing sugar like cake and ice cream cross their lips either.

http://www.childrenwithdiabetes.com/...as_insulin.pdf

Take a look at page 15 of this chapter of Dr. Hanas' book where she talks about children and birthday parties. Her belief is that people with diabetes shouldn't need to always stay away from things like cookies, candy, cake and ice cream because you can learn how to have them in moderation and with a little more fast or rapid acting insulin.

She's not suggesting that things like this should be done every day or every week, but that it's important for those with diabetes not to feel "different" and that they're able to join in the celebrations with everyone else.

Fast and rapid acting insulin begin working quickly, work hard, and then leave the system quickly also because they have no suspension in them which would delay their actions. This is why they're chosen to take care of meals.

It would take the NPH by itself longer to go to work on dealing with the bg rise from the carbs from a potato or anything else that's "carby". By that time, the bg's have gone up quite a bit. NPH, like the other intermediate and long acting insulins, have a means of suspension or are specially altered to delay their going to work right away.

If you do start with this, my advice would be to start slowly re: the amount of R you initially give Niki and see how things work. If you fed the same meal to three people with diabetes, all three of them would be giving you different bg readings 2 hours after eating because everyone handles food a bit differently. Some people say pasta in moderation is fine with them--others say they feel their bg's going up if they even THINK of pasta. Same is true for potatoes, rice and other foods with a lot of carbs in them.

A Happy and HEALTHY New Year to you and also to your "Faithful Sidekick"!

Kathy
  #10  
Old 01-01-2009, 09:35 AM
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Default Re: Using R along with NPH

Dolly,

I don't understand your reluctance to just give more of what she's already eating.

You will have to increase the insulin but no matter what you do to try to put weight on her you will have to increase the insulin to compensate.

I must be missing something.

Natalie
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