Daisy Vee

[k9diabetes]

Re: Daisy Vee

I think Marianne meant a fasting blood glucose check and then a check 1 hour after food and then every 2 hours after that. It gives you an opportunity to look at that first hour after you give the insulin and see how that compares to the second hour after, with checks done over several days at the same times to allow you to see how consistent she is too.

NPH usually doesn't cause a sharp drop so I'm not too concerned. Vetsulin has been known to cause a sharp drop in the first two hours so with that insulin I like to see some monitoring of that time frame.

Most common lowest blood sugar with NPH is around 6 hours.

We did actually use NPH at one time. It worked great for Chris' blood sugar as long as we gave it three times a day - didn't ever last a full 12 hours. But then he was allergic to the protamine so we went back to Regular insulin.

Without home testing, you really can't safely maintain such tight blood glucose control, which is why so many vets try to keep a dog's blood sugar between 200 and 300. With the variation that just happens and no home testing, they need that cushion.

A "fasting curve" can be a very interesting exercise because it allows you to see how the insulin behaves without the interaction of food. I know some dogs put on Lantus have had a fasting curve done first - insulin and no food - so it was possible to see whether the Lantus gave a smooth basal insulin supply.

With the steroid drops, it seems okay to me to let her run a little higher. After all, the cataracts are gone so you don't have to worry about those anymore! Once things settle down, you can get back to tighter regulation. It's great that you've been able to compensate for the effect of the drops.

I think I'm rambling.... !

Natalie

[ladysmom06]

Re: Daisy Vee

Hi Mike,

Welcome to you and Daisy. You have come to a great place for info and lots of support. As you can already see - the people here are so compassionate and caring. My Lady has diabetes and cushing's. She was dx with diabetes in Sept. 06 and everytime I think I'm starting to understand this disease Lady will do somthing that has my head spinning again - knowing I have a place to go where people get it makes things easier to deal with. Good luck to you and Daisy and please keep us posted. Hugs to the two of you.

Luv,
Lynne and Lady

[Brandy mom]

Re: Daisy Vee

Hi Mike

I have been reading your post. Daisy is very luckie to have you. Brandy was also on the Predisone eye drops after surgery. She was on them for a long time. I found that if I gave the Predisone eye drops at the lowest peak I could keep the number flatter. It took a lot of BG checks but if I gave the eye drops 30-45 minutes before the lowest point Brandy wouldn't get that high of a spike.

Dawn and the girls

[Mike Vee]

Re: Daisy Vee

Hi Dawn,
I'm eager to learn more about Brandy's experiences with the Prednisone. The vet I spoke to at Ohio State Veterinary Hospital says "it can elevate bg a little". I'm giving Daisy what I would have previously considered to be fatal amounts of insulin, just to get her to the mid-high 200s for glucose values.
I was actually doubting the Reli-On meter, so I confirmed the number with a OneTouchUltra. They are within four points of each other. Mike

[Brandy mom]

Re: Daisy Vee

Hi Mike

Each dog is different they will use insulin and other medication different. Both vet couldn't believe how the predsione eye drops effected Brandy. She would spike from 180's then 1/2 hour could be in the upper 300's. Just after surgery Brandy was on the drops 6x a day. I did the same thing you are doing using more insulin. The opth vet didn't think the problem was from the drops. Just a reaction to the surgery. It wasn't until Brandy starting getting the drop 2x a day that we had problems. At first we didn't know the drop were causing the problem.
I hesitated to say anything because each dog is so different. But I don't want you to end up in the same cycle. Because of the spikes the vet told me to increase the insulin. Then when the drops would wear off she had to much insulin this would cause a low. So several times I ended up treating a hypo. At first everyone thought she was having rebounds. This went on for many months. Because the drops were causing such a spike then a drop it looked like rebounds. Poor Brandy had the insulin amount lower so many times, just to get the BG in flat range. She would be in the upper 300's to low 400's before we could start to increase the insulin.
I had enough and told the vet something else must be going on. She needs more test. So his plan was to give Brandy X amount of insulin for 5 days without doing any adjustments (unless she had lows). Then he had me do a 24 hour curve for one day. Then I had to do 12 hour curves for 2 more days. Writing down ever thing Brandy did. I mean even when she went potty how long she walked and treats. After this was all done we sat down and looked at the information. He thought the drops could be the problem. So next plan was to take Brandy off the drops (with the opth vet approval for 3days), The first 2 day I did nothing just gave X amount of insulin. On the third day I did a 12 hour curve. So now we knew how Brandy would use the insulin without the drops. So we looked for the lowest point. He had me give the drops 15 minutes before the lowest point. Then I tested he BG in 1/2 hour(from the other curve this is how long Brandy would take to rise from the drops). She still had to big of a spike so the vet had me try 20 minutes ect.. We found that 30-45 minutes before the lowest point worked the best. So she was still spiking from the drops,but not as much.

Bet this was more information then you wanted to know. I should give you a little information on Brandy. She is a doberman and is at a slim 77 pound now. She has been diabetic for a little over 2 years. We found diabetes 1 day after her sixth birthday. She is also on thyroid medication and has arthritis.

Dawn and the girls

[rhodesian46]

Re: Daisy Vee

Thanks for clarifying what I meant I forgot to put fasting A blonde moment!

[Mike Vee]

Re: Daisy Vee

Bet this was more information then you wanted to know. I should give you a little information on Brandy. She is a doberman and is at a slim 77 pound now. She has been diabetic for a little over 2 years. We found diabetes 1 day after her sixth birthday. She is also on thyroid medication and has arthritis.

Dawn and the girls

Thank you Dawn,
That is exactly the type of experience I'm looking for. It verifies what I'm seeing with my Daisy. I'm giving the PredForte 4 times a day, along with other drops. The PredFort was the last one administered each time I gave drops to her. The surgery vets told me to allow at least 5 minutes between applications of the three differnet drops I'm giving at 4 intervals during the day. One BIG factor that I'm just noticing, is that when the PredForte are the *last* ones given, the BG numbers soar. However, when I wait the required 5 minutes between the different merdicines, but simply change the order so that something other than the PredForte is the last thing I put in her eyes, the BG numbers appear to be much lower. I spoke to my vet and we attribute this to dogs' eyes having sort of a drip-shelf (I forget the name of it) that keeps the last drops you gave them hanging around for a while, to be slowly absorbed. The last drops you administer occupy that space! My dog weighs 95lbs. I hate to think how these drops could hit a smaller animal. Anyway, this is all tennative. I have a really good relationship with my local vet, and he believes there *is* something to my suspecting the PredForte. He says to proceed with the usual caution and stay on the high side with the blood glucose readings. Like you, he insists that all dogs are different, and steriods can have little or no impact on one and big impacts on another. Like Brandy, Daisy is hypothyroid. There are dots to connect here, but I don't have the grey matter or education to complete the whole picture. Thanks again for explaining Brandy's drug adventures. - Mike

[Brandy mom]

Re: Daisy Vee

Mike

That is just one of Brandy's many adventures. Just a quick question. When is the last time Daisy had a T4 test? The only reason I ask is to me seems like diabetes and hypothyroid can go hand and hand. Was she DX with hypothyroid before diabetes? I have seen some dogs that were hypothyroid and then started insulin and the thyroid medication amount changes.

Dawn and the girls

[Mike Vee]

Re: Daisy Vee

Mike

That is just one of Brandy's many adventures. Just a quick question. When is the last time Daisy had a T4 test? The only reason I ask is to me seems like diabetes and hypothyroid can go hand and hand. Was she DX with hypothyroid before diabetes? I have seen some dogs that were hypothyroid and then started insulin and the thyroid medication amount changes.

Dawn and the girls

Daisy had one two months ago. I didn't understand what the vet was saying, but he sounded pretty much like what you wrote Our vet is big on blood analysis. He also did a fructosamine test then. Daisy's T4 test was where he wanted it, but the fructosamine revealed that I needed to test her glucose more. Her bg had been averaging pretty high when I thought things were under control and wasn't testing often. Mike

[Brandy mom]

Re: Daisy Vee

Hi Mike

I sure I am not going to explain this correct. But here goes.. Have you had your meter check against the vet labs? Humans and dogs have different blood (something I think cell size). So a human meter will work for a dog it just not a perfect number. So you need to have the vet check the dogs blood in the lab(not a meter). You use the same sample and check your meter. It will give you the differences then you just add or subtract that amount.

I sure someone else can explain this better HELP.

Dawn and the girls

[Mike Vee]

Re: Daisy Vee

Good point Dawn,
My vet told me they would be read very close, but human meters would exagerate at both of the extreme ends of the scale. However, I will insist the we do a side-by-side test the next time Daisy visits him. He has admitted to me that pro-active owners sharpen his skills in managing just about any disease. He and I get along really well. Regarding the blood tests, I'm fortunate that in Daisy's twisted world view, a blood glucose test is a "big treat". When I click the One-Touch lance, she gets all excited, comes running and lays on her side in front of me, so I can roll up her lip. Maybe it's because we've always praised and pet her before and after the sampling, and occasionally offered a small morsel to eat. It's a bizzare behavior to watch for sure.

[We Hope]

Re: Daisy Vee

Hi Mike

I sure I am not going to explain this correct. But here goes.. Have you had your meter check against the vet labs? Humans and dogs have different blood (something I think cell size). So a human meter will work for a dog it just not a perfect number. So you need to have the vet check the dogs blood in the lab(not a meter). You use the same sample and check your meter. It will give you the differences then you just add or subtract that amount.

I sure someone else can explain this better HELP.

Dawn and the girls

There's been a lot of talk about this, so I've just bumped up the thread we have about human and animal-validated meters.

http://k9diabetes.com/forum/showthread.php?t=77

As you'll see there, the majority of Feline Diabetes Board members are using human meters and aren't having issues with their accuracy because they aren't animal-validated. Having visited the board frequently, I don't see more people making "help! hypo!" than would be considered normal with any pet diabetes board.

Human glucometers aren't providing perfect numbers for people who use them either.

Depending on the way the given meter measures glucose--photometric or electrochemical--and the enzyme that given system uses to do that--hexokinase, glucose oxidase, or glucose dehydrogenase--all of them are able to vary.

http://clinical.diabetesjournals.org...eprint/25/2/43

Clinical Diabetes 2007| Evaluation of Inaccuracies in the Measurement of Glycemia...

In this article, the ADA recommendations are cited--glucose meter values should vary by < 15% from laboratory findings. A goal for readings > 75 is that they should be within 20% of what the lab says. For reading <75, 95% of those should be within 15 points of a lab test.

FDA wants all human meters (They must gain approval to be marketed, while animal-based ones are not subject to FDA approval before they are allowed to be sold.) to be within a 20% framework when the bg's are >100 and within 20 points when it is < 100.

The article goes on to cite that the newer meters were tested in 2005 and they were found to be able to give you values within 5% of a lab test.

There are also articles about the performance of various meters (depending on the type of enzyme used to measure glucose) under conditions such as high altitudes and low temperatures.

http://care.diabetesjournals.org/cgi...urcetype=HWCIT

One of the problems with meters is that we have many groups with their own standards on what's acceptable and what isn't.

http://care.diabetesjournals.org/cgi.../full/30/2/403

"Much of the difficulty with assessing the performance of POC glucose measuring devices lies in the lack of consensus among professional and regulatory groups regarding allowable error. As a result, published studies are often difficult to directly compare. Of these, the ADA guidelines established in 1996 are the most stringent, calling for total error (bias plus imprecision) of <10% for current devices and <5% for future devices. Error grids have been used in an attempt to predict clinically important errors; however, they are comparatively inaccurate."

And then we get into where the blood comes from--capillary or vein, plasma or whole blood re: accuracy:

"Differences between sources of blood may be amplified in the postprandial state (72,75–77). During periods of fasting, capillary glucose may be only slightly (2–5 mg/dl) higher than venous plasma glucose. After a glucose load, however, capillary glucose values may be 20–25% higher than venous plasma values."

"Glucose from plasma generally exceeds that of whole blood. In 2001, the International Federation of Clinical Chemistry recommended that glucose meters be calibrated to plasma glucose, using a constant factor of 1.11. In fact, most, but not all, meters today are calibrated to report plasma glucose values."

FDA's rules and regs re: human glucometers are over 20 years old--this is what determines if the product gets approved to go on the market. They've been trying to change their regs for more than 10:

http://www.fda.gov/cdrh/ode/gluc.html

http://www.fda.gov/cdrh/oivd/laboratory.html#tip6

"Have you ever wondered why you got a bad glucose meter test result when there is nothing obvious wrong with your meter, your test strips are new, and you’ve been running glucose tests for years? The simple answer is that glucose meters are not perfect, and neither are the people who use them!

"Check the results from your meter against laboratory results as often as possible.

"Over time, test systems can drift apart. Since results from either test system maybe used to treat your patients, it is important for the systems to remain synchronized."

So here you see them telling people to check their meters against lab values frequently.

Even people are being told to compare their meters with their lab tests, as you see FDA advise above, so any addition or subtraction of points would need to be done on that individual basis--you, knowing how your meter stacks up to lab testing.

[Mike Vee]

Re: Daisy Vee

<big snip> Even people are being told to compare their meters with their lab tests, as you see FDA advise above, so any addition or subtraction of points would need to be done on that individual basis--you, knowing how your meter stacks up to lab testing.

Good stuff! I'm going to compare my daily use Relyon unit to the vet's meter when I get a chance. When I have reason to doubt the reading, I also have a one-touch-ultra-mini and a one-touch-utra full size that I've used. The one-toch brand strips are twice the cost of the Relyon. I haven't seen more than a 4 or 5 point difference, but I'm curious about the canine specific meters and how they wll compare.
mv

[Mike Vee]

Re: Daisy Vee

This might be posted in the wrong place, but while on the subject of meters, I mentioned how close my OneTouch and Relyon meters have been for me. Your results may vary. The strips for the OneTouchUltra cost me approx $1 each. I just returned from buying strips & insulin at Walmart, and 100 Relyon glucose test strips came to $42.48. That's less than 43 cents per test. My sister (mom to a 14 year old with type 1) told me about the relyon meter when I was complaining about how many strips I consume. She does alot of voluteer work with JDRF (Juvenile Diabetes Research Foundation) and is generally pretty informed on the *human* type one issues. I'm eager to test the Relyon against the vet's clinic meter in a few weeks after reading the very informative WE Hope post. Mike

[k9diabetes]

Re: Daisy Vee

I haven't tried the Relion meter but I buy the strips for the OneTouch Ultra at www.hocks.com. Costs about 2/3 of the local pharmacy price. You can likely find them cheaper elsewhere too but I buy a handful of diabetes supplies through Hocks - test strips, syringes, and lancets - so it's easiest just to call up my order history there and refill what I need.

The OneTouch Ultra I use is a pretty consistent average of 30-40 points low against a lab value and against the AlphaTrak throughout a wide range of BGs for Chris.

But you're so right - depends on the meter, depends on the dog. There's no way to know how your meter on your dog will compare to a lab value in advance or by how it does for another dog.

Freestyle, as a general rule, has a pretty good history with small dogs and with cats but not as good with larger dogs from what I've seen generally. It wasn't nearly as close for us as the OneTouch.