Soaphie the sophisticated is an angel October 29, 2015

[k9diabetes]

Re: Soaphie

Kathy gave a good overview of all the reasons why Vetsulin/Caninsulin can result in some sharper drops in BG than NPH.

The combination of a lack of resistance because the insulin molecule is identical to a dog's natural insulin molecule and a more dilute solution gives a tendency at least for that to happen.

Our dog was a good example of one who processed zinc suspensions like Vetsulin and protamine suspensions like NPH very differently even though his zinc lente insulin was a U100 human-origin insulin -- Humulin L, which is no longer available. He got a pretty even supply of insulin from the NPH protamine version but took a long time to "break open" the zinc suspension of Humulin L (no longer available).

I'm just very glad we still have at least two choices of insulins. Every time an insulin type goes away, pets suffer. Humulin L was a really great insulin for a lot of dogs and Vetsulin/Caninsulin is not an exact substitute for it - a good thing for dogs who need something different, like Kathy's Lucky, but a bad thing for the dogs for whom Humulin L was the perfect insulin.

[Soaphie & Sydney's Mom]

Re: Soaphie

Ok - I think I have given it the 'ol college try with Vetsulin. Soaphie is low (again) this afternoon. I came home from work due to a big storm we are getting here in upstate NY and she wasn't acting quite right....I gave her some banana, and 20-30 minutes later she still wasn't acting right. So I tested her....52 (it's about 13% lower than at the vet). So I gave her some karo....waited 15 minutes and she still wasn't acting right so I gave her some rice and more karo. She's now sleeping by my feet. I called the vets office - and no vet is in the office right now.

So - my question - any advice on dosage after tonight's meal?

Argh. I will be in the vets office on Monday and we are done with Vetsulin - I feel like we've tried every dosage/food combination possible. My poor baby...

[We Hope]

Re: Soaphie

When you do get hold of your vet, ask him/her if he/she prefers to cut the dosage tonight by 30-50% or to omit tonight's shot. Some vets prefer to cut the dose, while others would rather skip a shot--it depends on what your vet prefers and what Soaphie's bg's look like as you continue to keep an eye on them.

Until you can go Monday, you'll need some type of "working" dose of insulin, so it would also be good to find out from your vet how many units Soaphie is to get starting tomorrow on a regular basis over the weekend.

Kathy

[Soaphie & Sydney's Mom]

Re: Soaphie

I won't be able to talk to anyone tonight - so I think my plan will be to cut in half tonight and talk to the vet in the morning. Ugh.

[We Hope]

Re: Soaphie

If you cut by half, you can be sure there will be no more hypos tonight. She will obviously be running high, but this can get straightened out after you are able to talk with your vet.

Kathy

[rhodesian46]

Re: Soaphie

Good choice to go 1/2 Better high than low. Are you planning on switching to Novolin N? I think it is a good idea besides the cost You get more insulin i than in the Vetsulin( 2 1/2 more times) Pebbles did well on Novolin N . ALso you need to have an emergency number or a contact # just in case you need to speak to someoneHope Sophie does well this evening

[Soaphie & Sydney's Mom]

Re: Soaphie

At 6:20 p.m. she was at 113 (this is 1/2 hour after eating her dinner and three hours after karo/rice). I gave her 8 units. We are just all over the board with Vetsulin. I have really really really tried - I didn't want to rush to change just to have to change back. But - I think it's time. A few weeks ago we were at 14/14 and her levels were high....then moved to 15/15 and I did a curve last weekend and she was low so I dropped her to 14.5/14.5 and here we are again - low. It absolutely breaks my heart to see her this way - up until this summer when she was diagnosed, she would run up to 10 miles with me - she was my training partner. Life isn't fair

I will be on the phone with the vet that is on duty tomorrow (not our normal vet - but she is familiar with Soaphie's case).

Thanks all!

[k9diabetes]

Re: Soaphie

Re: Insulin

NPH works so well for so many dogs - plus is easy to obtain and can be used with lots of different needle gauges... I think it would be great to try Soaphie on it and see how she does.

You may find, in the end, that it's her metabolism that's at the root of this variation rather than the insulin. But the only way to know is to try and you really don't have anything to lose by trying it either. At worst, you go back to Vetsulin and reduce the dose so you don't risk winding up in hypo territory.

I know one dog who did the same thing on Vetsulin and she was actually transitioned over to Regular four times a day, the same schedule Chris was on. I think that dog was allergic to NPH. Both she and Chris did very well on Regular faster-acting insulin as their only insulin!

Our dog is a good example of the world of difference the insulin preparation can make. His curves on the old Humulin L and NPH were like night and day in terms of how he absorbed the insulin. The endocrinologist was fine with the swings, but we were not and changing the type of insulin got rid of them.

Re: Exercise

I don't know that Soaphie will ever be able to run 10 miles at a stretch again BUT she certainly should be able to get to the point where she can get some good exercise!

It's a variable that's usually best left out of the equation when you're first working on regulation. But once you find an insulin / diet combination and know how she handles them, you can start to introduce exercise again and see what that does, starting with small amounts and working up to a level she can safely handle.

Most dogs will see their blood sugar drop during exercise, in which case you can give some carby snacks or even glucose prior to going out and while out to keep the blood sugar adequately high.

I believe some people actually see their BG go higher from exercise... if that's the case with Soaphie, it might not be enough to be a concern or it might be a matter of proper timing... there are ways to do it when you have a fair amount of home testing experience and can identify her particular patterns.

Chris was never a runner - his heart had always been compromised from his PDA and he never had much stamina - but he went on walks all through his diabetes. As he got sicker, the walks got shorter, not from the diabetes but from his heart problems. I would check his BG before we left and give him some glucose if I was concerned about the level of his BG starting out. And we tried to time the walks so they weren't at his lowest BG level.

Re: Emergencies

As for the vet availability issue, do you have any 24-hour options available in your area?

We have identified a 24-hour clinic that's near us and we call them after hours if we absolutely need help, which we have a few times. We are fortunate that we also have used their specialists a few times so they know us and had a file on Chris. In fact, the clinic owner was the one who helped us when we had to let Chris go - she had a special place in her heart for Chris.

Our original vet kept one doc on-call but hardly any clinics still do that - which is understandable. Now, since we have a half dozen 24-hour hospitals here, they pretty much all just ask clients to call the ER vet in the case of an emergency.

I know some vets don't bother with any options for overnight or weekend emergencies... I think that should be illegal! I hope that's not the case for you guys as it is scary going it alone and some situations just won't wait for office hours!!

Okay... I've written a book!!

Hope Soaphie and you are feeling more relaxed now!

Natalie

[eyelostit]

Re: Soaphie

I'm sorry about what you and Soaphie are going thru.
It was months and months of my 1st vet that kept uping the insulin until Niki went into shock, she was at 18 units of NPH at the time, now she is at 9 1/2 or 10 units for yrs now. I was so digusted with the vet, found this board and put Niki's life in my hands and never looked back.

This is no reflection on your vet, but the lows are scary, better highs than lows.

Hang in there.

[Soaphie & Sydney's Mom]

Re: Soaphie

Tomorrow morning I'm meeting with a new vet for Soaphie. The switch from Vetsulin to NPH will begin. In my brief call with the new vet on Saturday, she stated that NPH is the gold standard and that many have come to her to switch. Here's my question - she said that the switch would be gradual....part vetsulin / part NPH for a while until it all becomes NPH.

Has anyone else done a transition like this?

[We Hope]

Re: Soaphie

We switched species three times. Each time we did so, it was just begin using the new insulin, period. I know others who have made transitions to either human or pork insulin and they did the same thing--began the new insulin at a modest dose, leaving the old one behind. Don't know of anyone who made a change like the one proposed for Sophie.

Kathy

[We Hope]

Re: Soaphie

http://www.vetsulin.com/vet/DosingConverting.aspx

This is transitioning from human insulin to Vetsulin. There's no mention of the need for a mixture of the two insulins at all:

"When an insulin change is necessary, one must be very cautious. Due to the nature of the disease, it is difficult to have general guidelines; however, some recommendations can be made:

"If regulation is already adequate, it is suggested to start Vetsulin at 50−75% of the dosage used with the previous insulin.

"If ideal regulation has not been achieved, it is suggested to first investigate the cause of poor regulation: eg, owner administration issues, insulin storage issues, use of improper syringes, Somogyi overswing, etc. Once it has been determined that the dose of the previous insulin is inadequate, start Vetsulin at 75−100% of the dosage used with the previous insulin."

Jenny, who is a member of this board, needed to switch Buddy from Caninsulin/Vetsulin to NPH; AFAIK, she did no transition like the one your new vet detailed. There were also two others who were members of another diabetes board who needed to make the switch from Caninsulin to human insulin, and I know they only stopped using the Caninsulin/Vetsulin and started using the human product.

From a personal standpoint, when neither human nor beef insulin were doing anything for Lucky, we were eager to leave the old insulin behind with the hope that the new one would be what he needed.

Lucky's switches from human to beef to pork, were supervised by our vet, as were the transitions from pork Lente to pork NPH and back to pork Lente, made necesssary by Lilly's discontinuation of their pork Lente and his having issues with both the protamine suspension and different preservatives of pork NPH. Since he was intolerant of everything in the pork NPH except the pork insulin itself, we were only to happy to be able to stop using it for him.

Kathy

Adding here--one of the dogs from the other board was initially placed on Insuvet Lente-U 100 bovine Lente insulin available only in the UK. The insulin did not work quickly enough for him because of the two amino acid difference between bovine and canine insulin.

He was then switched from Insuvet Lente to Caninsulin/Vetsulin. That worked too quickly for him because more dilute insulin work faster than less dilute ones and the amino acid match between pork insulin and canine insulin is a perfect one.

He was finally switched to U 100 NPH insulin and the combination of the less dilute insulin and the one amino acid difference between human and canine insulin provided him with what he personally needed to manage his diabetes.

He wasn't switched by mixing any of these insulins any more than Lucky was.

[Soaphie & Sydney's Mom]

Re: Soaphie

After the lows we have been having - I want to be done with it and not look back.

Thanks for your advice!

[k9diabetes]

Re: Soaphie

Everyone one I know who has changed just switched immediately to the other insulin at a reduced dose and worked up to the right level of insulin units since it can definitely vary.

Which makes me wonder a bit about this vet's recommendation in terms of other advice she might give... she may not be used to people who home test blood glucose... ? I can't think of any reason really to do that.

[BestBuddy]

Re: Soaphie

Hi,
Buddy made the change from Caninsulin to Humulin N overnight. He had been well regulated on the Caninsulin for nearly 4 years before we struck trouble hence the change. He was on 4.8iu of Caninsulin at night and we made the change to 4iu of Humulin N the next morning. His numbers didn't change, meaning the highs and lows were the same number with each insulin just the timing of them changed. We had to increase a bit to 4.5iu but are now back to 4iu and doing great after a diet change. Caninsulin saved my boys life and gave us 4 more years so I have nothing but good things to say about it but I have noticed with the NPH that I am able to get a flatter curve which makes getting better numbers easier.
Jenny & Buddy