Cara earned her wings last nite

[We Hope]

Re: Cara - Need a shoulder!

Kathy - I take to heart all your remarks about needle-gauge and length. If anybody has doubts, always the first thing to do is discuss the matter with your vet (this also assumes your vet is knowledgeable on the subject!).

Kathy, I tried to find detailed information about the needle-plugging idea, but the page wouldn't let me in! I think you'd mentioned that before - all you see is mention of the possibility!

Since Cara is on Vetsuin (which would have the larger crystals, I gather), Marion, you could stick with, say, 29-gauge, half-inch needles and use the other techniques to help avoid pain with the injections (making sure there aren't any air bubbles, and warming the insulin to well above room temperature - say, 15 to 30 seconds in your armpit, with the syringe filled, and the needle capped, of course!)

I also agree that if ANYBODY tends to be a bit absent-minded, it's better not to use "the wrong syringes." (But when doses are really stable, and you're not altering them at all, you can mark a syringe barrel with a waterproof pen, to remind you where to measure to.)

Oh, and another matter! Kumbi has never objected in the slightest to my picking up skin, and hiking it up as high as it will go. It seems clear Lucky would not tolerate such a maneuver!

So, everything depends on the individual dog!

I do believe that IF you are reaching your goal well - that is, placing the needle so it shoots into the layer of fat under the skin, AND the insulin is somewhere near the dog's body-temperature when injected, the effect is that the injection is painless.

Another thing I'm not SURE of is, whether warming Vetsulin (Caninsulin) that much affects the potency! It seems not to be a problem with Novolin NPH insulin; my vet approves of my warming the insulin this way.

Kathy - when you say, 90 degrees - do you mean perpendicular to the body? I find I'm holding the syringe between 45 and 90 degrees to shoot into Kumbi's hiked-up fold of skin.

Fri, 7 Nov 2008 19:55:57

Though we don't get an abstract, this PubMed citation refers to needle plugging; Monotard was Novo Nordisk's non-North American name for their Lente insulins--when they still made any Lente here, it was called Novolin L:

http://www.ncbi.nlm.nih.gov/pubmed/7...ubmed_RVDocSum

There's never been an abstract there to read--the notation refers to the larger Ultralente crystals being capable of plugging some needles. This would be a possible issue with Lente insulins (and Ultralente, when it was still sold) only.

http://petdiabetes.wikia.com/wiki/In...n#Cold_insulin

Insulin can sting, regardless of what species, type or brand. Bringing the insulin to room temperature by removing it from the fridge before actually using it can help avoid painful injections. Warming the capped insulin syringe with your hands can have the same effect.

http://care.diabetesjournals.org/cgi...5/suppl_1/s112

http://www.petalk.com/feline-diabetes.html

Some people tuck the capped and filled syringe under their arm for a few minutes to warm it before use. Do NOT attempt to warm insulin using a stove, microwave, etc.; you may destroy the insulin by doing so.

This is an attempt to show you how I held the syringe when giving Lucky's shot.

Now we'll try taking a look at syringes and compare.

[We Hope]

Re: Cara - Need a shoulder!

Marion,

You might see if you're giving Cara's shot with the needle's bevel side up.

http://k9diabetes.com/forum/showpost...33&postcount=9

The bevel is meant to slide under the skin--here you can see how it's pointed and angled, and how it could be painful and possibly tear the skin if it was turned upside down for a shot.

http://diabetesindogs.wikia.com/wiki/Syringe#Barrel

U100 syringes barrel and markings chart

http://diabetesindogs.wikia.com/wiki/Syringe#Barrel_2

U40 syringes barrel and markings chart

Right now, you're giving Cara 14.5 units of Caninsulin in a U40 syringe. If you were to convert the dosage to use a U100 one, that would make for 36.25 units in a U100 syringe.

So you're filling about to here--------------------*

These are U100 syringes--the bottom one is a 3/10 syringe and holds up to 30 units--36.25 is more than that, so they'd be out unless you want to give two shots in place of one. The top one is a 1/2 cc syringe that holds up to 50 units, so you could use that or the 1 cc ones that hold up to 100 units of U100 insulin.

You would be filling this one to about here-----*

Kathy

[Cara's Mom]

Re: Cara - Need a shoulder!

Kathy, that is most certainly something to check for!!!Vet never told me to make sure the beveled side is up, but I will from now on. Thanks!

[k9diabetes]

Re: Cara - Need a shoulder!

I posted my question on another thread before realizing this one had turned to obtaining U40 syringes with finer needles in Canada.

Sounds like it may be more difficult than I hoped.

Conversion information is available here:

http://www.medi-vet.com/Insulin-Syri...sion-Chart.htm

and

http://felinediabetes.com/insulin-conversions.htm,

with those links both listed at www.k9diabetes.com/complinks.html.

I've seen a number of people make the conversion and never have any problems with the insulin crystals.

Definitely HAVE seen problems with people doing it and not understanding the difference between the mark on the U100 syringe they fill to and the number of units of insulin, and that has always been a big concern as I would hate to have them rush the dog to an emergency vet late one night and say they are giving 10 units when they're really only filling a U100 syringe to the 10 mark and delivering 4 units of insulin. So for me it's absolutely a requirement to understand the difference in terminology and to know how many UNITS of insulin you are actually giving if you're going to make the conversion.

Natalie

[Cara's Mom]

Re: Cara - Need a shoulder!

Natalie,
That conversion is the reason I am not too keen to switch to U100 syringe.
Kathy might have found me a place , Calvet Supply, that carries the U40 Ulticare syringes, 29 gauge. They claim they ship to Canada and I hav e-mailed them for more info on shipping cost. Will let you know!

[Cara's Mom]

Re: Cara - Need a shoulder!

Cara's insulin has been reduced...again! Over the last weeks Boss Vet has been reducing it from 14 1/2 to now 13 1/2. Her premeal Bg's are too low. Been as low as 4 (72). After meal Bg have been between 22 (396) and 18 (324). By noon she's down between 6 (108) and 4.9 (88).
Vet keeps telling me it's her meal that's doing this! Have taking out the tablespoons of cottage cheese (has some sugar in it). Vet wants more fibre!
She still gets snack at bed time.
To me this is too scary, going so low. Even on lower units!. She's been on same diet since start, so maybe he's right. But what about "rebound"?
Had to do curve for him:
Forgot the AM premeal !
AM
6:00 meal and shot
8:00 19.6 (352)
10:00 8.9 (160)
12:00 4.9 (88)
2:00 5.4 (97)
4:00 6.1 (110)
5:45 6.2 (112) before meal
6:00 meal and shot
10:00 bedtime snack
This morning premeal 4 (72)
6:00 meal and shot
8:00 16.7 (301)
What do you think? Will be talking to Boss Vet later this morning.

[Debbie & Apollo]

Re: Cara - Need a shoulder!

HI

all I can really add is that when Apollo changed food we saw a drop in his need for insulin.
we really had to keep a close eye on his levels. And yes we also did a lot of questioning ourselves.... "can this be possible??"

We have also found that now that he is adjusted to the new food, his activity level has changed ...well ... we had to increasing his insulin dose slighty and I take him back for a curve in a week.

good luck -- you're keeping a good eye on Cara.

Debbie and Apollo

[Cara's Mom]

Re: Cara - Need a shoulder!

Hi Debbie,
There have been no changes in Cara's food at all. Well, no just couple days ago I took out the cottage cheese. That was only 2 tbsp and the drop in Bg had already started before that!!
Those furry kids sure keep us on our toes, don't they!

[Debbie & Apollo]

Re: Cara - Need a shoulder!

They keep us on our toes and on pins and needles!

Sorry, I thought there had been other food changes besides the cottage cheese.

Ok -- Cara --stop messing with your Mom! LOL

Debbie and Apollo

[k9diabetes]

Re: Cara's BG

It's plain cottage cheese?

Cuz dairy is typically (every dog is different but usually) digested slowly and is effective at slowing down digestion (not sugar in it, is there?). So I would leave that in.

There are a few possibilities....

One is that I have noted a definite tendency for blood sugar to be more level when it is too high and then to show some sharp spikes when you get down into better numbers. This could be what's happening with Cara.

Rebound remains a possibility. I have been worried for some time that there are times when her BG is dropping to low at the nadir.

Could be interrelated... the lower blood sugar levels are starting to show sharper spikes and those sharper spikes are causing her to sometimes go too low.

6:00 meal and shot
8:00 19.6 (352)
10:00 8.9 (160)
12:00 4.9 (88)
2:00 5.4 (97)
4:00 6.1 (110)
5:45 6.2 (112) before meal
6:00 meal and shot
10:00 bedtime snack
This morning premeal 4 (72)
6:00 meal and shot
8:00 16.7 (301)

She's dropping lowest at 6 hours post injection, which is pretty common - food is probably mostly processed and gone by that time but the insulin still has some kick.

She's getting a sharp rise in BG from her food but it is brief and the rest of the day looks really good.

I know you don't like the 300 readings but when you look at what her BG is over the whole day, it's great. You're talking about maybe four hours of blood sugar that's higher than you want but only briefly.

So first, don't panic about those readings!! It's a few hours a day that is otherwise at great numbers that, for safety reasons, probably should come up a bit given Cara's tendency to have low days.

You may be able to reduce those 300s with diet tweaks and cutting out any quickly digested foods would be the key. The question is what are the quickly digested foods and sometimes they aren't what you might think.

Chris, for instance, digested a high protein / low carb canned food very very quickly so he got a spike like you are seeing with Cara after eating even though he was on Regular, faster-acting insulin!!

Kibble on the other hand he digested slowly and adding it to his diet gave him a spike of blood sugar about 5 or 6 hours later! The opposite of what you might expect.

________

Marion, I'd suggest that you work first on the insulin and I do think dropping the dose is a good idea. Work toward the low numbers being in a safer range so that when Cara has an unexpected low day she will be safe.

Ignore the 300s... I know that's hard to do but I promise you that they are far from the end of the world. If she had a fructosamine test right now I'm sure it would show pretty good regulation since it reflects her average and you have about 18 hours a day in great numbers and 6 in not as great numbers.

When you have the insulin dose in a good place - BG safely not too low - then you can try to very slowly, methodically, and in small amounts, make diet variations and see what effect they have on Cara's curve.

Don't make any assumptions about what "should" get digested more slowly. Try one thing at a time, either more or less of that thing... things being dog food (canned and/or kibble), meat, dairy, carbs such as rice or oatmeal.

When you start working with the diet, change one thing, let it ride for a day or two and test to determine the results.

You don't need to do full curves. Spot check important points - premeal, 2 hours after eating/injection, and 6 hours after eating/injection since those are the key points you are trying to shift. You are trying to

- drop the BG at 2 hours
- raise the BG at 6 hours

You will be looking for something that takes longer to digest so first guesses would be dairy, meat, fiber.

____________

If this curve, raised slightly for safety, winds up being the best Cara can accomplish, that would be okay!! Realistically, a lot of dogs just don't get perfect regulation. And a dog whose blood sugar is 180 all day versus a dog whose blood sugar is mostly 120 with a few hours at 300 probably aren't very much different - just variations that amount to about the same amount of excess blood sugar.

There'a a lot of beauty in this curve!! And Cara is doing well - she's telling you not to worry too!

Natalie

[k9diabetes]

Re: Cara - Need a shoulder!

Here is what Chris' curved looked like on R... I have to go back and see what we were feeding then.




This was on half canned California Natural Chicken and Rice or Canidae Chicken Lamb and Fish and half cottage cheese. Both those canned foods have chicken as the primary ingredient and rice as the only carb.

[k9diabetes]

Re: Cara - Need a shoulder!

We lived with the spike in his BG because we wanted him on canned rather than dry.

[Cara's Mom]

Re: Cara - Need a shoulder!

Thanks Natalie, that sounds reasuring!
Yes, there was sugar in the cottage cheese! It was the 2% type!
Her meal consist of 3/4 c kibble (Sience diet adult lite), 4 oz of cooked chicken breast, 4 oz of WD canned and 1/2 cup chopped-up green beans. The only thing I can think affects the Bg to go up would be the WD canned...and that might be the same food that Chris spiked on!
You know, it's not the spikes I am so concerned about...it's the deep drop after those spikes!! You have told me enough times not to worry about 300readings, that it finally sunk in. There is no perfect world! Even if we crave it!!
Still waiting for Vet to get back to me, with his feed back on the curve.

Quess we posted at same time!!!

[k9diabetes]

Re: Cara - Need a shoulder!

You don't have to look at the "end of the spike" as a deep drop. It's not necessarilly strong insulin action at that point as the surge of glucose may simply be running out so the blood sugar naturally drops.

A dog doesn't necessarily rebound from a drop like that. Chris never did.

It looks to me like the BG isn't plunging, it's just returning to where it was before the spike. If it was dropping significantly below the premeal level, that would be a concern. But after the spike the numbers are relatively flat, which is a good thing.

I see no evidence of rebound in this curve at all. Just a quick digestion of something and I'd guess it's the dog food. Not sure if it's the kibble or the canned but it wouldn't take long to figure it out.

[k9diabetes]

Re: Cara - Need a shoulder!

I'm not sure if that was clear... let's assume the spike of glucose from her breakfast peaks at 2 hours and then runs out so she's not sending a lot of glucose into her bloodstream at 3 hours. Her BG would drop to a more "normal" level because she's not being flooded with glucose anymore.

If you're filling a draining sink with water, the water rises as long as the faucet is on full bore. Turn down the faucet and the drain catches up.

If there was a huge kick of insulin occurring at the same time, her blood sugar would hit the basement when that spike from breakfast ran out and that would be truly dangerous.

That's not what I see happening. It came down fairly gradually. 160 at 4 hours and then down into the hundreds another 2 hours later. Essentially flat thereafter.

So there's a good match of food and insulin after about 3 hours. It's the first couple that are off.