Dog diagnosed 1/30... Need advice/help!

[Lolo]

Re: Dog diagnosed 1/30... Need advice/help!

So if you treated your dose as is being 17 units a possible equivalent dose of levemir would be about 4 units . Not sure if i would be comfortable with matching doses to start and i would probably go lower so not to start off giving to much as that really affects regulation and safety

They provided a chart for me that basically recommends different dose levels based on what her glucose level is and whether she eats all or half of her food. I’m a little nervous and like you tempted to go lower and be conservative. I’m even more tempted to change her food first, which will take about a week to fully transition, and then intro the new insulin. I don’t think they wanted me to wait that long, but they’re basing the recommended levels on her readings over the last few weeks and the food she’s eating probably played a role in those numbers. Makes me nervous to change both at once.

[Judi]

Re: Dog diagnosed 1/30... Need advice/help!

If I were you I'd go with your instincts on this one

[Lolo]

Re: Dog diagnosed 1/30... Need advice/help!

If I were you I'd go with your instincts on this one

I think you’re right. It’s just hard when it feels like your dog is a ticking time bomb. You just want to act fast before more damage is done. She over 400 for at least 4-5 hours every day. She’s over 500 right now
But levemir does seem a little scary. I know that a difference of 1 unit of 70/30 can have a big impact on Lucy’s lows so how do you make small needed adjustments with a drug where 1 unit has the power of 4. It’s intimidating.

[jesse girl]

Re: Dog diagnosed 1/30... Need advice/help!

You must also remember The r component of the 70 /30 is wildly different from levemir so you may have a rough start to begin with getting the body use to this different acting insulin . Without the R component you may struggle to see sugar lower and have to put up with higher numbers across the board until you find the dose that moves the numbers lower

I have not heard of anyone going from 70/30 to levemir . Like we talked about its unusual to start with 70/30 . Usually the switch was done based on NPH insulin not working well .Many times it was because of resistance to NPH insulin on a fairly high dose and struggled to lower blood sugar that you did not see but R insulin may have artificially gave that impression

I really dont agree with your vets philosophy on how they approach insulin therapy but i believe levemir maybe a better choice than 70 /30 . I still would have transitioned to just nph see what the curve looked like and see if levemir is appropriate before trying it . I dont like just kind of grabbing at straws and like a more methodical approach .

The one thing we dont know is how your dog will react but most i have seen that transitioned to levemir did ok to good not allot info but enough to give a consensus

[farrwf]

Re: Dog diagnosed 1/30... Need advice/help!

Looks like only 3 have used it, 1 in conjunction with a fast acting. I'm with Jesse Girl, ... would've checked out the NPH "N" first.

Poll: POLL: Update us on the insulin you're using

Levemir only ILoveRotties, thomasgunnar 2 3.33%

Levemir and a faster acting insulin (not NPH) diggydog 1 1.67%

[Lolo]

Re: Dog diagnosed 1/30... Need advice/help!

[FONT=Tahoma][SIZE=3]Looks like only 3 have used it, 1 in conjunction with a fast acting. I'm with Jesse Girl, ... would've checked out

i don’t really know what to do. Both my vet and the new internal med specialist said N won’t last any longer than 70/30. I’ve been charting Lucy’s numbers over the past 3 weeks and they do show she’s just using up the insulin at about the 9 hr mark. She wakes up btwn 400-500 and at the 9 hr mark after her AM dose she’s back up to 400+. Increases in dosage bring her lows down but don’t budge those 9 hr+ numbers. At the current 17u she’s had lows around 80-90 at peak, but her numbers still increase to 400-550 from 9-12 hrs. I do see why the specialist is seeing those results and saying levemir.
My question is whether 70/30 is making her lows lower than N would, but my vet said the answer is no.

[CraigM]

Re: Dog diagnosed 1/30... Need advice/help!

Can’t be sure, but I’m thinking there could be two reasons for the BG increase at around the 9 hour point:

1). As the vet thinks, the insulin duration isn’t long enough. Not sure if straight “N” would have a longer duration than 70/30, but it may?

2). The body needs “feeding”. The body is able to release stored glucose, but a diabetic can’t make insulin to go along with the released glucose and the BGs increases. I’ve read (human diabetes) that this release of stored glucose may happen after 5-6 hours (everyone is different), and recommend a tiny snack between meals and at bedtime.

I realize this goes against our 12 hour feeding guideline, but you might try a small snack around the 7-8 hour point. My theory is that the small snack might prevent the larger glucose release you are seeing at 9 hours. No harm in trying this for 2-3 days?

Just guessing!

[CraigM]

Re: Dog diagnosed 1/30... Need advice/help!

Are you giving any medications during the day? I recall some of Annie’s eye drops caused a BG jump.

The snack I mentioned in the previous post probably wouldn’t prevent such a large spike, but who knows. When I take a cheese snack just before bedtime, my morning BGs are a few points lower than when I don’t eat the bedtime snack. Then again, I’m a type-2 so I guess My body still make some insulin.

[Lolo]

Re: Dog diagnosed 1/30... Need advice/help!

Am I right that switching from Novolin 70/30 to N is an easy transition on their system? I mean 70/30 is really just a blend of N and R right?
On 70/30 she hits her peak low at hour 4 and then slowly rises over next 4-5 hrs and then shoots up. Is it possible that the N and R are both working their magic at hour 4 and driving her lower in combo with each other? Then the R stops its action and it’s really just N working from then on.
I guess my main question is does a higher dose of N equal it lasting longer? Or does it just mean lower peak but same duration overall? Because if a type of insulin only lasts so long in the system (and if she just metabolizes it quickly) then switching to 100% N from a blend won’t help me.

CraigM - I give her eye drops at night (around 7:30p) so that’s not it. And as far as a snack I’ve never tried something specifically at hour 7-8 but I have tried at different times and what I’ve given her seems to raise her BG. I’ve tried homemade chicken jerky and homemade pumpkin (+wheat flour, egg). What kind of treat or snack do you think would help? She’s slightly allergic to dairy.

[Lolo]

Re: Dog diagnosed 1/30... Need advice/help!

And another question... would eating food with ingredients that have a high glycemic index (potatoes) make her use insulin more quickly? I should really learn more about nutrition. Just wondering if maybe the change in diet (new food arriving next week hopefully) could possibly make her get a little more time out of the insulin.

[CraigM]

Re: Dog diagnosed 1/30... Need advice/help!

CraigM - I give her eye drops at night (around 7:30p) so that’s not it. And as far as a snack I’ve never tried something specifically at hour 7-8 but I have tried at different times and what I’ve given her seems to raise her BG. I’ve tried homemade chicken jerky and homemade pumpkin (+wheat flour, egg). What kind of treat or snack do you think would help? She’s slightly allergic to dairy.

you would need to experiment. Maybe a small Milkbone that would feed her body, without causing her to release stored glucose. This might increase her BG, but hopefully not as much of a spike? Again, I’m just guessing.

Of course if you are making a food change next week these experiments might not hold true with the new food (or a switch in insulin).

[Raysaint]

Re: Dog diagnosed 1/30... Need advice/help!

From my knowledge of insulin, the N part of the 30/70 may not be running out, but it surely is weaker later in the day. Going to straight NPH, (with a higher dose probably needed) would probably make it stronger later in the day, and probably would make her nadir occur later than the 4 hour mark.

Even if insulin is running out late in the day, if it's stronger before it runs out, it should keep sugar down a bit more before fasting.

A change in food might be good to have slower release ingredients, so that post prandial spikes aren't as high. The R is dealing with that, but without R, numbers may be higher a little longer after meals.

Prior to doing all of this, you might try the snack midday and see if it makes a difference. Be careful with biscuit type treats as they are usually high carb. See what the main ingredient, and probably a small piece.
I use small pieces of dried sweet potato or a couple banana chips.

[Lolo]

Re: Dog diagnosed 1/30... Need advice/help!

So I still haven’t totally decided what to do, but I am very glad I delayed switching her to Levemir. For the past 4 days she has been dropping below 100 at peak (4-5 hrs). She actually hit 52 yesterday! She’s been at 17u of Novolin 70/30 for almost 2 weeks and no immediate changes in dose or diet have been made, but just over the last few days it seems the dose is too high for her. I did open a new bottle recently and maybe it’s just more potent?
I took her down to 16u (just a hair over... maybe 16.25) last night and this morning and she still dropped down to 90 today. I gave her some treats just to be safe and so she wouldn’t drop lower. I don’t know what’s going on. I’m wondering if it’s just her getting more distance from the Temaril/steroids, skin issues, antibiotic for the skin issue, likely allergy to beef liver treats that was revealed by recent allergy tests. Maybe as everything else normalizes (no more antibiotics, skin issues, liver treats) she’s needing less insulin? Or maybe I just got a stronger bottle of 70/30 with a little more than 30 of the short action.
Unfortunately she’s still in the 400s at the 8-9 hour mark until next dose. I’m trying to manage it somewhat by taking her for a 10-20 minute walk at 5p to bring her down at a peak high time. This naturally brings her numbers down significantly, but her hind legs still aren’t great so I need to keep them brief. Also wondering how this will work when it’s 115 in AZ in another few months : (
It’s confusing.

[Riliey and Mo]

Re: Dog diagnosed 1/30... Need advice/help!

theirs a quick change in Lola,s blood sugar since you started a new bottle of insulin.

her fasting number of 90 is too low

I.d keep dropping her back 1 unit keep testing with no other changes.

she's doing great keep up the good work

others will chime in

mo

[Raysaint]

Re: Dog diagnosed 1/30... Need advice/help!

With her dropping low 4-5 hours in, and going a bit high at 9 hours in, still makes me think you don't need the R fast acting insulin. With straight NPH the 4-5 hour mark would be a bit higher, and more NPH would be left for the later part of the day.