changing to Levemir with Addisonian dog

[Gayle Davis]

Hi all - I am new to this list - haven't been on prior due to dial up that makes downloading this format difficult, however, I'm feeling a bit desperate at this point and I'm looking for support and advice from anyone in a similar situation - my Min Pin, Chester, was dx'd with Cushing's in Dec of 2011 - he was treated with Trilostane for 4 mos and went into crisis on Apr 19, 2012 - at the same time his adrenals quit altogether, so did his pancreas, and he became diabetic at the same time he became Addisonian - he has remained Addisonian since, and must have Prednisone every morning - I have gotten him down to the lowest effective dose, and he gets 0.25 mg/day - nonetheless, the Pred has wreaked havoc with his blood glucose - his numbers are wildly erratic, and rarely good - he has been on Humulin NPH and at the advice of his internal medicine specialist, he has rec'd as much as 10.5 iu BID - at that dose, he has been even more screwed up, with LOs and HIs and one hypoglycemic episode on Jan 5th that nearly killed him because he couldn't keep food down - we got him thru with IV therapy - I have insisted on keeping his insulin reduced by 20% until his bgs stabilize, but they never seem to - and the Humulin does not seem to last him 12 hrs - he is currently on 8 iu BID, and oddly, for the first time since this started last April, he has been consistently in the mid-300's for over 3 days now at both of his fasting bgs - and, it figures since I just went and got Levemir as a last ditch effort to try and stabilize and lower his bgs the IMS is suggesting I start him on 0.5 iu of the Levemir - it's such a tiny amount I'm worried I'll mess up and not get that little half a drip into him! but, my big concern is how much risk there may be of hypoglycemia occurring - has anyone had experience you would be willing to share on making the transition to Levemir? particularly if you have an Addisonian dog? I would be so grateful - I plan to start him Saturday when I will be able to have 5 straight days with him if necessary - I already worry I'm going to come home some day to a dead dog because of a hypo- episode again, and now I'm a wreck about actually getting decent bgs finally! crazy, eh?

I apologize for my length - trying to paint the whole picture - many here already know Chester from the Cushing's, Addison's, and other diabetes lists, and most will agree he is a complicated case - he does not respond normally to any protocol for any of his issues - he's a happy guy, tho, and eats well, exercises happily, and has adapted to 100% blindness as of Sept 24, 2012 - and he makes me laugh every day with his antics, so I want to do what's right for him -

thank you for your time, thoughts, and experiences!

Gayle - caregiver for Chester, the complicated Min Pin, 10 yrs, M/N, 6.1 kg

[Mpollww]

Re: changing to Levemir with Addisonian dog

Hi Gayle,

i have a min pin as well who has had numerous issues with her diabetes and pancreatitis and we are now starting testing for Cushings. The people here have been wonderful!

I'm sure there will be someone along shortly with knowledge who can help but in the meantime - welcome!

[Judi]

Re: changing to Levemir with Addisonian dog

Hi Gayle, My Jenny went addisonian with too much Lysodren. She was on prenisone for 4 months last year until her cortisol slowly came back up.

Her vet prescribed liquid prednisone and using a small syringe I was able to give her the pred twice a day vs. once a day. It helped a lot.

hang in there. Judi

[momofdecker]

Re: changing to Levemir with Addisonian dog

Welcome to you and Chester. Sounds like you've had some very scary times.

Have a few questions for you.... Are you able to home test? It seems min pins can be a bit challenging in that area but thought I'd ask none the less . How often is the prednisone dosed....morning? evening? both? Do you have any recent NPH curves you could post so folks can get an idea of how the insulin was processed? Is Chester fed/injected every 12 hours?

There are a couple of dogs on here who have addisons and diabetes. Can only remember one off the top of my head....Karen and her girl Sammie. Link to her thread is below if you are interested in reading:
http://www.k9diabetes.com/forum/show...ghlight=Sammie

My boy was switched from NPH to levemir in May 2012 but he was 98 pounds at the time and had a host of other things going on that we were also unaware of at the time. In Dec. 2012 he was put on prednisone for inflammation relief for spinal cord compression.

Holli

[heinzle]

Re: changing to Levemir with Addisonian dog

Hi Gayle! We have talked over in the Add forum. Glad you found your way here!

I only have one suggestion that you should discuss with your vet. I found that the prednisone, while it increases blood sugar, also is directly responsible in stabilizing it. Too little prednisone will cause the LO BGs (it is actually a symptom of untreated Addison's due to the lack of cortisol in the system).

I tried lowering Sammie's dose of Prednisone from 2 mg to 1.5 mg and really saw a difference in her curve becoming more erratic.

I am suggesting a bump up in her dose of Prednisone may help level out her BG numbers.

[Rubytuesday]

Re: changing to Levemir with Addisonian dog

Hi Gayle, Kudos to you for hanging in there. I also have a dog with multiple diseases that make diabetes control difficult. It can be rough, but the support of this group has helped not only in managing Ruby's care, but managing my emotional roller coaster that comes with it.

I don't have any experience with Cushings or Addisons, but I have seen posts from Natalie suggesting that splitting the dose of pred from once a day to twice a day can help. As the pred can dramatically effect BGs it is better to have that affect be constant throughout the day rather then waxing and waning through the day.

Tara

[Patty]

Re: changing to Levemir with Addisonian dog

Just wanted to add my welcome to you!

[Gayle Davis]

Re: changing to Levemir with Addisonian dog

I wanted to say THANK YOU to everyone for sharing your thoughts, as well as your warm welcomes to the group - my brain is fried tonight and so I am going to fore go a post until tomorrow evening when I hope to have my head together enough to ask the questions generated by your comments - I appreciate the suggestions, and will mull things over a bit more, then post tomorrow - thank you all!

[BogiesMom]

Re: changing to Levemir with Addisonian dog

Hi Gail,
I wanted to also add a warm welcome My dog Bogie is on Levemir insulin although he doesn't deal with the other health issues that your Chester deals with.
Dawn

[Gayle Davis]

Re: changing to Levemir with Addisonian dog

HI again everyone - last few days have not gone according to plan and I am late in getting back on here - thank you again for the warm welcomes!

Mpollww - if I can be of any help regarding the Cushing's and your Min Pin, please feel free to ask!

Dawn and Patty - thank you for welcoming me!

Tara, Judi, Karen and Holli - regarding Prednisone - Chester does get his pred in the morning only - I am hearing you say, however, that dosing twice daily might help keep his bgs more in line - that would definitely require me to get it compounded into liquid, which is no problem - I'm curious about the effects of twice-daily dosing since the half-life of Pred is 18-36 hrs - they shouldn't wane that much in 24 hrs, but then, this is Chester, and he doesn't do anything by the book - so, I will discuss going BID with his IMS and vet - as for raising his dose of pred overall, Karen, I have to admit I am reluctant at present to do so - he seems plenty energetic, hikes in the woods with me daily for 2-3 miles, and has never required a boost of pred - I am so so concerned about his liver, among other things, and specifically reduced his pred to .25 mg/SID to try and prolong his liver function - his IMS objected to the reduction but only because of the neuro-deficit he suffers from in his right rear leg - this deficit is short-lived after he first wakes up and walks, and then he is fine - he does not appear to have any pain associated with it whatsoever - so, for the time being, I'm going to sit tight with .25 mg/day, probably split it, and see how things go with the Levemir - if we are still messed up, I will look into increasing the Pred -

Holli - yes, I home test - I have from the git-go and Chester, even tho he is a Min Pin (and yes, I know the reputation they can have ), is extremely cooperative about everything I do to him - I check both his fasting bgs before meals - he jumps on the bed (which is on the floor these days in case he ever oversteps with his blindness) and I check his bg, give him green beans, put eye drops in, give green beans - then he's fed and jumps on the bed afterwards again - I give his insulin, green beans, eye ointment, green beans, and brush his teeth, green beans - he would do pretty much anything for his green beans His fasting numbers have been erratic - all over the place - for some dang reason the past week he has been consistently in the mid-300's - a first! but, I have been trying something new for the past two weeks of taking about twelve pieces of kibble on his afternoon hike and feeding him bits as we go - that was I have avoided any LOs after his walks, as the LOs then resulted in rebounding and HIs -

as for his curves, each has shown that Humulin simply does not last 12 hrs for him - in hours 2-4 or 6, his bgs decrease, then they gradually start to increase dramatically until he is high again for much of the afternoon - and by high here, I mean 400's-500's - his last curve was on the 19th of February and he did NOT get a hike that day due to my poll work, and his curve did as described above -

today I started him on the Levemir - I administered 0.5 iu this morning with a fasting bg of 415 - this afternoon I checked the bg before we hiked as I didn't want him to be tanking or something, and it was 515 - we hiked, very little food given (four pieces) and it was 472 at fasting - so, so far the Levemir is not cutting it, but I know he has to adjust -

how long would you guys wait before you increased the Levemir if his numbers stay high? we're trying to avoid a hypoglycemic episode, but I hate seeing his numbers stay high for too long knowing it's ravaging his little body -

and for those of you with Addisonian dogs, have you heard much about the correlation of high blood sugar leading to higher Potassium levels? Chester has to have his Percorten every 21 days, and I am hoping I can blame the frequency on his diabetes, subsequently hoping if I control the diabetes, his K might come down on it's own and maybe I can get to the Percorten being dosed at 28 days instead -

thanks again for suggestions and encouragement - I will swing all ideas past the IMS and my vet -

Gayle and Chester, who's signature line I will attach this time as it give his history, and please feel free to remark if you see any discrepancies that might be messing things up for us: with Chester, rescued/adopted Min Pin, 6.1 kg, 10 yoa, M/N, treated with Trilostane for Cushing's (PDH - dx'd 12/11) - Addisonian crisis with onset of diabetes in April, 2012 - status now: iatrogenic primary Addison's, diabetes, complete cataract blindness, mild proteinuria - current meds: 0.5 iu Levemir insulin BID, Pred 0.25 mg SID, Percorten V 13.2 mg (0.52 ml) @ 21 days, Flurbiprofen eye drops BID, Optimunne ophthalmic ointment BID, Benazepril 2.5 mg BID, aspirin 4 mg SID, Omega-3 360 mg SID, cranberry capsule BID, Bilberry capsule SID, Tbl yogurt SID, Tbl Pumpkin BID, Wellness CORE Reduced Fat, green bean snacks - 02-01-13 - 10 day course of Baytril 22.7 mg, one BID, for UTI - Chester is flanked by Curly Joe, Border Collie/Boxer, and Bailey, shepherd/lab

[Mpollww]

Re: changing to Levemir with Addisonian dog

Thank you for the offer Gayle! I've been reading a lot on the Cushings site and it scares me to death ! I thought diabetes was bad..... My husband is going to visit his family for a week so I've decided to wait until he gets back to the ACHT/stim test.

Good luck with the Levimir. Cooper is on Humilin. We're not going to make any changes until we figure out about the Cushings.

[momofdecker]

Re: changing to Levemir with Addisonian dog

HI again everyone - last few days have not gone according to plan and I am late in getting back on here - thank you again for the warm welcomes!

Mpollww - if I can be of any help regarding the Cushing's and your Min Pin, please feel free to ask!

Dawn and Patty - thank you for welcoming me!

Tara, Judi, Karen and Holli - regarding Prednisone - Chester does get his pred in the morning only - I am hearing you say, however, that dosing twice daily might help keep his bgs more in line - that would definitely require me to get it compounded into liquid, which is no problem - I'm curious about the effects of twice-daily dosing since the half-life of Pred is 18-36 hrs - they shouldn't wane that much in 24 hrs, but then, this is Chester, and he doesn't do anything by the book - so, I will discuss going BID with his IMS and vet - as for raising his dose of pred overall, Karen, I have to admit I am reluctant at present to do so - he seems plenty energetic, hikes in the woods with me daily for 2-3 miles, and has never required a boost of pred - I am so so concerned about his liver, among other things, and specifically reduced his pred to .25 mg/SID to try and prolong his liver function - his IMS objected to the reduction but only because of the neuro-deficit he suffers from in his right rear leg - this deficit is short-lived after he first wakes up and walks, and then he is fine - he does not appear to have any pain associated with it whatsoever - so, for the time being, I'm going to sit tight with .25 mg/day, probably split it, and see how things go with the Levemir - if we are still messed up, I will look into increasing the Pred -

Holli - yes, I home test - I have from the git-go and Chester, even tho he is a Min Pin (and yes, I know the reputation they can have ), is extremely cooperative about everything I do to him - I check both his fasting bgs before meals - he jumps on the bed (which is on the floor these days in case he ever oversteps with his blindness) and I check his bg, give him green beans, put eye drops in, give green beans - then he's fed and jumps on the bed afterwards again - I give his insulin, green beans, eye ointment, green beans, and brush his teeth, green beans - he would do pretty much anything for his green beans His fasting numbers have been erratic - all over the place - for some dang reason the past week he has been consistently in the mid-300's - a first! but, I have been trying something new for the past two weeks of taking about twelve pieces of kibble on his afternoon hike and feeding him bits as we go - that was I have avoided any LOs after his walks, as the LOs then resulted in rebounding and HIs -

as for his curves, each has shown that Humulin simply does not last 12 hrs for him - in hours 2-4 or 6, his bgs decrease, then they gradually start to increase dramatically until he is high again for much of the afternoon - and by high here, I mean 400's-500's - his last curve was on the 19th of February and he did NOT get a hike that day due to my poll work, and his curve did as described above -

today I started him on the Levemir - I administered 0.5 iu this morning with a fasting bg of 415 - this afternoon I checked the bg before we hiked as I didn't want him to be tanking or something, and it was 515 - we hiked, very little food given (four pieces) and it was 472 at fasting - so, so far the Levemir is not cutting it, but I know he has to adjust -

how long would you guys wait before you increased the Levemir if his numbers stay high? we're trying to avoid a hypoglycemic episode, but I hate seeing his numbers stay high for too long knowing it's ravaging his little body -

and for those of you with Addisonian dogs, have you heard much about the correlation of high blood sugar leading to higher Potassium levels? Chester has to have his Percorten every 21 days, and I am hoping I can blame the frequency on his diabetes, subsequently hoping if I control the diabetes, his K might come down on it's own and maybe I can get to the Percorten being dosed at 28 days instead -

thanks again for suggestions and encouragement - I will swing all ideas past the IMS and my vet -

Gayle and Chester, who's signature line I will attach this time as it give his history, and please feel free to remark if you see any discrepancies that might be messing things up for us: with Chester, rescued/adopted Min Pin, 6.1 kg, 10 yoa, M/N, treated with Trilostane for Cushing's (PDH - dx'd 12/11) - Addisonian crisis with onset of diabetes in April, 2012 - status now: iatrogenic primary Addison's, diabetes, complete cataract blindness, mild proteinuria - current meds: 0.5 iu Levemir insulin BID, Pred 0.25 mg SID, Percorten V 13.2 mg (0.52 ml) @ 21 days, Flurbiprofen eye drops BID, Optimunne ophthalmic ointment BID, Benazepril 2.5 mg BID, aspirin 4 mg SID, Omega-3 360 mg SID, cranberry capsule BID, Bilberry capsule SID, Tbl yogurt SID, Tbl Pumpkin BID, Wellness CORE Reduced Fat, green bean snacks - 02-01-13 - 10 day course of Baytril 22.7 mg, one BID, for UTI - Chester is flanked by Curly Joe, Border Collie/Boxer, and Bailey, shepherd/lab

Gayle,
I'd give the .5 levemir dose at least five days to settle in. Keep checking for ketones and lots of fluids. Curve then evaluate to determine how best to increase.

[Gayle Davis]

Re: changing to Levemir with Addisonian dog

thanks, Holli - it's going to be a long wait........... it makes me so nervous when his bgs are so high - I do check for ketones - and he drinks GALLONS of water when he's running this high - this morning his fasting bg was 486 - I just have so much trouble thinking of all the things that ravage his organs - Prednisone, high blood sugar, kidney issues with the proteinuria - it's hard to be patient for things sometimes I appreciate the advice, and I'll wait it out -

Gayle

[Rubytuesday]

Re: changing to Levemir with Addisonian dog

Hey there, I only have a second, but wanted to respond to this:

might help keep his bgs more in line - that would definitely require me to get it compounded into liquid, which is no problem - I'm curious about the effects of twice-daily dosing since the half-life of Pred is 18-36 hrs - they shouldn't wane that much in 24 hrs, but then, this is Chester, and he doesn't do anything by the book

I think whatever the half life of pred it would be better to split it. Theretically if it last 18hrs and has 6hrs without it that would chage insulin requirements. Better to have some of it on board all the time with some overlap as that would keep the insulin requirements a bit more consistent. Insulin requirements would go from more to a little bit less rather then more to a lot less.

I'm not suggesting that you change the insulin dose to compensate. Just that by splitting the pred dose it will create a more even curve. You might even get to the point where you could dose his pred for the overlap to happen during his low point thereby creating a flatter curve.

Tara

[Gayle Davis]

Re: changing to Levemir with Addisonian dog

thanks, Tara -I certainly agree with your thinking on this - when I first planned to reduce Chester's Prednisone from 1.25 mg/day to .25 mg/day, my regular vet wanted me to stick with splitting tabs rather than compounding the Pred - I never asked her why, but I'm assuming she felt there might be inconsistency in dosing with the liquid due to settling, uneven distribution of pred in the suspension agent, etc - however, there is no way I can split a quarter of a 1 mg tab as I'll have nothing but dust, and, Pred tabs are now back ordered, all sizes, so compounding is soon to be the only way to go

as I am understanding the action of Levemir, we shouldn't see as many peaks and lows anyway like we've seen with the Humulin, and perhaps dosing the pred BID will help maintain that even keel, as several of you have said - I'll see my vet Thursday and discuss this with her - thank you again!

Gayle