Mik is gone...

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

will do-thanks

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert,

Please let us know!

Kathy

[eyelostit]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert,

I hope Mik is OK,
Welcome to the board ! Niki and I are late feeders

[BaileyBear]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert, I'm so sorry to hear about your wife's passing and everything you and your pups have been through. I had no idea when I originally posted.

Ketones are an emergency situation. I hope you were able to get in tough with your vet or take Mik to an emergency hospital and that he is OK. Hang in there and let us know how he (and you!) are doing when you get a chance.

Holding you and your pups in my thoughts.

[k9diabetes]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert I see that you are here now... how is Mik?

It looks like you are not too far outside my neighborhood... you'll have to let me know who your vet and clinics are so I can put them in my database of local vets.

So glad you got the strips and checked on him as I didn't like what I was reading about him. I hope they got him started on some insulin tonight.

Natalie

[angelbudsmama]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Hi Robert...We have not "met" yet....Just wanted to say welcome, and that you are in my thoughts as you navigate through this situation with Mik! I read your posts...hoping that insulin got going tonight, and if you were able, some fluids at an ER facility to flush those ketones out....

One of my best friends, Michelle has two Shih-Tzu's..and they are DEF. picky eaters. They won't eat anything in the mornings. Managing a diabetic pup in that scenario makes it doubly hard. Hang in there!

Once you get your routine going, there are lots of goodies that are legal that you can put on Mik's food to get that appetite going! Over the years, I have tried them all! (: As far as the 12 hr schedule goes, my vet in the beginning was pretty insistent that you try to follow the 12 hour rule. Once things get regulated and figured out, I was advised an hour window was okay either way. But, you really need to first see how Mik processes the insulin before you adjust your timing too much.

I know this is all so overwhelming, but please know we all are/have been in this big diabetic boat together, and we won't let you go under...we will figure it out. I am sorry for the loss of your wife...she sounded like a lovely woman who cared for your dogs deeply.

Blessings,
Judy in Arizona ( mom to my Angel Bud ( rat terrier, 6 years diabetic, 13 yrs old, passed on Feb. 17) and Harley ( my sweet Aussie/retriever mix)

[Margaret Boyle]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Another odd one. At times, Mik goes for this water bowl and just whimpers and cries. He dips his mouth into the water, gets wet, but it seems that he cannot drink.

Almost like he forgot how, or something wrong with his mouth.

I pick him up and hold him, try to get his mouth open [which he really hates] than usually within a few minutes is able to drink water.

I have never seen this before.

First keton reading was moderate, about 40, but it keeps getting slightly darker after the 15 seconds. Maybe to 60. The instructions say "exactly 15 seconds." He sees the vet first thing in the am.

Hallo Robert and welcome I have been reading about the problems you are having with your pup, you have came to the right place you will get all the support you need they are a great team and know their stuff.
I am sorry to hear about your wife Robert this must be very difficult for you.
They will all help you with your wee pup.
I am quite new myself so I know how you feel.

LOL

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

It's been a busy night and morning. Last night, Mik's ketone test strip was moderate. Got to vet and he began insulin--"Vetsulin" at 5mg. [1 mg/kb + 1 =4+1]

Vet tests show high glucose but like links on this forum, does not want me to adjust insulin based on glucose test strips. He wants me to monitor water consumption and ketone tests.

I guess glutose test strips can have 'spill over' which affects readings.

Vetsulin is used once a day, unless treatment is ineffective, then adjust to twice a day with about 70% each time, or 4 mg 2x/day

Vet was not overly concerned with diet at this minute, getting whatever food Mik will eat. He also explained maple syrup or sugar water if insulin is too much. He said overly lythargic, dizzy, confused and falling over might be a sign to use sugar water.

I am reading everything I can on Vetsulin.

Complicating this, his brother Mak went into some kind of reaction to his heart medicine so that was another two trips to vet to adjust his meds.

Busy 12 hours.

[k9diabetes]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Hi Robert,

How much does Mik weigh?

Insulin is usually measured in units of insulin -- perhaps it's 5 units. Are you to fill the syringe to the 5 mark?

Natalie

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert,

The business with the urine strip testing, unless you need to look for just ketones, is that what you see in urine is basically a "delayed report"; this is the amount of glucose you would have seen in the blood 2+ hours before. (There is a meter which tests blood for them, but the strips are VERY expensive-close to $50 for a pack of 8.)

When you get to 180 mg/dl and stay at that reading or above for a while, the glucose starts to spill into the urine; it's called the renal threshold. If there are no times when the bg's have been at or above 180 and remained there for a time, you will simply get a negative on the glucose reading. Getting a negative tells you the dog is reading somewhere under 180 and that can be a big "somewhere". It can't tell you whether he/she is too low. Testing blood can tell you that and it also provides information about how much glucose is in the blood right now--not 2 + hours ago.

And now to Vetsulin. Vetsulin is an intermediate-acting insulin, just as the human NPH you've seen written about on this board is. It's not a long-acting one shot a day insulin, but needs to be given twice a day.

Otherwise, you're trying to "stretch" it and here's how. With the one shot a day plan, you give all of the insulin in the morning, after breakfast. Then you need to give an larger meal 6-8 hours after you've given breakfast and the insulin shot.

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

Dogs administered insulin once daily

"The first meal (e.g. 1/4-1/3 of the daily ration) is given prior to the morning insulin injection. This allows the owner to see that the dog is feeling well and eating normally before the insulin is administered.

"The second meal (the remainder of the daily ration) is usually given about 6-8 hours later."

What you're attempting to do with the second, larger meal is to have it start digesting before the insulin "peaks", or is working the hardest. If this doesn't happen, you run a very big risk for having a serious hypo because there's a lot more insulin in the system than there is food to handle it.

When I was on another board, every one I knew who had tried the once a day insulin regimen had to switch to twice daily to get their dogs regulated. One friend in Belgium, tried for 7 months to get her dog regulated; she failed until the insulin dose was split and given 12 hours apart, after breakfast and after dinner. I lost track of how many times there was a rush to the vet or ER because he was in a serious hypo. After splitting the dose, he regulated very easily and quickly.

My Lucky was the first US Vetsulin patient who had not been involved in an earlier trial. At the time we needed it, Vetsulin had not yet been approved for use in the US, so we had to file paperwork with FDA to gain permission to import it for him.

Lucky was resistant to both human and beef insulin; only a perfect match to a dog's own insulin, which is pork insulin, was effective for him. He initially regulated on Lilly's Iletin II Lente, which is the same type of insulin as Vetsulin. The difference here is in the strength of the two. Lucky took two shots of that a day, just as he did with the human and beef insulins which did nothing about lowering his blood glucose.

When Lilly discontinued Iletin II Lente and Lucky had intolerances to the suspension and preservatives in Iletin II NPH (pork NPH, which they still made at the time), the only hope to help Lucky was to get him back on pork Lente insulin. We made no secret of the fact that we intended to use the Vetsulin/Caninsulin just as we did the old Lilly pork Lente--by body weight and twice a day.

Lucky was about Mik's age when he was diagnosed with diabetes and he could give you an 85 mg/dl between 8-10 hours after breakfast and morning insulin. He never had a hypo and was able to keep wonderful control on his twice daily Vetsulin.

I believe you'd do much better with the twice daily insulin. How much does Mik weigh? Lucky weighed 9.5 lb and 4 IU twice daily was the dose that kept his bg's so well in control.

Kathy

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

I fully understand a twice a day regiment, but it's impossible to get Mik to eat anything in the morning. He is not a gobbler, but a picky eater, one lick at a time. Always been that way, and now with diabetes, I must get some wt on him but he will not eat.

I have tried dry, vet approved can, kibble, baby food, a/d prescription food, boiled chicken, etc. In the am, he will just walk away. Around 11 is the first interest of any kind with food. He has been this way for years.

This was one reason the vet chose Vetsulin because of the one\day dosage. Of course, I don't disagree with anyone on this board--you people are the PHD's, and I'm in the first grade.

But I also know that Mik will not eat in the early am, and I cannot give him insulin on an empty stomach. My choices seem to be one/day, twice/day, but reading the steps on the link you provided [and came with the insulin] both suggest the early meal.

I can manage the insulin at whatever time makes sense, but I cannot force feed mik in the am. He simply will not eat, never has, and does not appear likely to change.

So, I dare not inject him in the am on an empty stomach.

Second option appear to be a meal + injection around noon-1. But that pops the other problem, Mik is zonked out by 9. I have never tried to wake him at midnight for a meal. I can do that, but can't know the results yet.

I have other questions about testing, but will put them into my next reply. many thanks!

Oh, Mik weighs 10.2 pounds, and yes, it's 5 units of insulin. That much I can do.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Okay, basic, grade school level. I have read countless pages on diabetes, and would just like to confirm my understanding in simple terms.

1: food contains sugar/glucose.
2: the body processes this glucose
3: when the body cannot process it properly, blood sugar goes up, patient gets sick
4: when the process is failing, we can see it with high readings on the glucose and ketone test strips.
5: inecting insulin will process the body's glucose.
6: test strip readings go down
7: if the readings do not go down enough, the insulin can be adjusted
8: if the insulin is too strong, the reverse happens and the body is glucose starved [hypo]
9: if that happens, maple syrup [vet's suggestion] will elevate the glucose but if bad enough [coma] trip to ER

Am I close? I am trying to understand the basics

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert,

I have seen people who have needed to deal with diabetes for themselves or for a family member on two or four feet, who didn't "get it" as well as you do!

Kathy

[k9diabetes]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Hi Robert,

I am concerned that the starting dose of insulin is quite high.

They often do this when trying Vetsulin once a day but wishing and hoping that he will get a slow delivery of the insulin over 24 hours doesn't make it so and, as a result, that high starting dose can be just plain too much insulin in the first few hours after injection.

Until the insulin brings his blood sugar down some, he may be able to tolerate that large dose but after a few days there is a good possibility it will be too much.

My dog was one who was very sensitive to insulin. At 60 pounds, he never needed more than about 12 units per injection.

I don't like to see them start with more than 1/4 unit per pound, which in this case would be 2.5 units.

Which means Mik will need very careful monitoring of his blood sugar. I would test his urine with the ketodiastix several times a day and if his urine tests drop rapidly down to moderate to trace glucose only in the six to eight hours after his injection, you need to contact the vet immediately about reducing his insulin dose.

I know you have had a lot to absorb in a few days but...

Please consider home blood glucose testing. There are video and picture tutorials here: www.k9diabetes.com/bgtestvideos.html. A small dog like Mik is probably easiest tested on the back at the base of the tale but I have also seen small dogs tested on the lip. With Mik, I'd recommend a Freestyle meter to start.

[k9diabetes]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

As for the eating and injection schedule, there's no harm in trying once a day and see what you get - but he will need very careful monitoring.

Just know that, in my experience, 98% of dogs will need two injections a day to regulate their blood sugar.

However, there is another option that not many vets consider...

Most dogs can have 1/4 to 1/2 their insulin dose if they do not eat. This is insulin that is needed for the "basal" need for glucose - the insulin that keeps glucose going into our cells when we don't eat anything.

So one alternative if a dog just flat out refuses to eat twice a day is to give a normal dose of insulin with a meal, say at 11am as Mik is used to. And then, 12 hours, later you can give 1/4 - 1/2 the usual dose and no food.

I have seen this done with a couple of dogs and I could routinely give my dog 1/3 of his insulin dose if he refused to eat, as he did in later years when he was not well.

Home blood glucose testing will allow you to monitor his reaction to 1/4 of his usual insulin dose and no food, once he's established with a With-Food dose.

So I just want you to know that there are creative ways to manage this kind of problem because there are some dogs who just won't eat in the morning no matter what you do.

I am sorry you have had such a harrowing 48 hours... you will get there and we can help you come up with some creative solutions to whatever challenges Mik presents to you. No doubt some your vet would not be familiar with!

How is Mak doing?

Natalie