Newly Diagnosed, having issues

[Neirracul]

Re: Newly Diagnosed, having issues

Hi all,

We’ve been on 11 units twice daily for around 10 days now and we just finished another curve today. Actual numbers haven’t changed much but the S-shape of the last curve is replaced by a rather flat-ish one. It worries me that it looks like either a stuck in rebound curve or a resistant curve. Is it too early in regulation to tell? I assumed that when the vet had her hospitalized for several days they would have tested her for other issues since they couldn’t get her sugar to come down below 400, but maybe not? I kind of loathe the idea of taking her back there since they couldn’t even tell she was in rebound in the first place. She’s still on Vetsulin since we haven’t gotten any of the Relion yet.

1. 371 - fasting
2. 458
3. 446
4. 479
5. 436
6. 451
7. 416 - fasting again

[jesse girl]

Re: Newly Diagnosed, having issues

Your still at around a starting dose for a 62 pound dog at 11 units . The curve is flat and shows no sign of rebound . You can move it a bit faster doing a curve once a week and adjust the dose if needed . You maybe able to go up another unit and do another curve next week . A flattened curve is easier to regulate and you have that within the last 2 curves that you posted . Good job

[Raysaint]

Re: Newly Diagnosed, having issues

keep the process going, increase a unit for a week, do a curve, repeat.
It takes some time, don't expect quick results or changes. It'll get there.
Diabetes will throw you some curves, but stay the course, don't overthink something that defies your expectations or the textbook.

My 25 lb dog is on 9 units of Humulin, so 11 units is low as yet for your dog.

[Neirracul]

Re: Newly Diagnosed, having issues

Thanks everyone! Feeling a lot better about things and just focusing on staying the course. Maura hasn't had any clinical signs of diabetes for weeks now which is great. She does get sleepy when her sugar goes too high, but she seems to have a little more energy every day and plays and gets the zoomies much like she used to.

We had a few bumps in the road recently since FedEx "lost" her food for over a week until we opened an investigation and then the next day it was unceremoniously dropped on our porch. We ran out for... 2 days? and had to feed her ground beef and veggies for those meals. Eventually we will switch her to home cooked meals/homecooked plus Dr. Harvey's but we currently don't have a big enough freezer for the meat and getting meat reliably will be very difficult for the next who knows how long because of COVID-19. Will be keeping her at 12 units for an extra week to restabilize.

Maura is currently eating Ketonatural's Chicken formula which is less than 10% carbs and so far is eating it reliably. The salmon gave her bad gas, horrible breath, and she actually started refusing it so we switched her and everything seems to have improved. She's getting 2.5 cups a day for a 60 lb dog and has even gained a few pounds (hopefully muscle) from more regular exercise. Her current dose is 12 units of Vetsulin in the morning and 12 units at night for a total of 24 units per day. We are on our last bottle of Vetsulin and I've purchased some Novolin N (ReliOn) to prepare for the switch. Vetsulin is $75 a vial from our vet and that's just way too unaffordable, so hoping she responds well to the Novolin N.

Raysaint- does your pup get 9 units total or is it 9 twice per day? I haven't figured out how the dosages really line up between dogs since it seems like some dogs only need one injection per day and others need two or more. Either way, you're right and Maura is still only around the starting dose. I'm /definitely more interested in taking things slower than trying to go too fast - especially since she started rebounding at 20 units. Her ideal dose is somewhere under 20 and we will get there soon enough.

As far as switching insulin goes, since she's only around the starting dose now I was going to switch directly to 12 units of Novolin N. Does that sound right? Even going to a 1/5 unit per pound starting dose on Novolin would be 13 units so it seems like it should be fine. Also where does everyone get their U100 syringes? I have an almost full box of U40 syringes left and would like to finish them off with a converted dosage of 4.8 units Novolin (I think). But after that we will need the U100s. The brand I currently get is vet prescription and I don't know how my vet will take the switch to Novolin so I was hoping to avoid that route if possible. (We recently moved and they are a new vet for us and we do not have any rapport). The syringes are over $30 a box from the vet, too. They love upcharging things here.

[jesse girl]

Re: Newly Diagnosed, having issues

Walmart has u100 syringes under the relion name that I think are about $12 per box of a 100 . I get the 30 unit type with half unit markings . They have different lengths and gauge of the needle depending on how thick the skin and fur is .Glad things have settle down a bit and your getting into a new normal

[Raysaint]

Re: Newly Diagnosed, having issues

my dog gets 9 units twice a day, after each meal.

If you do home cooked food, keep the meat low fat, i.e. chicken breast.

And absence of clinical signs is a good thing, my vet has to remind me of that, as I get focused on numbers too much (being diabetic myself).

[Neirracul]

Re: Newly Diagnosed, having issues

As far as the syringes go, I can’t seem to find the ReliOn ones. I asked the pharmacist and they only sell them open box, either by singles or in tens and they’re very expensive like that. The Walmart website doesn’t seem to have them either. Going to have to order some from an online nonrx website somehow. Ugh. They don’t make this stuff easy, do they?

[jesse girl]

Re: Newly Diagnosed, having issues

I think 5 years back Walmart in my area had the same policy and you could not buy a box of 100 without a prescription . You could by the insulin and a bag of 10 syringes . The reason for the syringe policy as explained to me as they were concerned about drug addicts . I would go to Nevada twice a year to visit my mom where they did not have that policy and you could buy as many boxes of a 100 you want so I stocked up twice a year . The Walmart in my are eventually changed their policy back to being able to buy a box of 100 or more and I was happy about that.

You may want to check other Walmarts if they have the same policy and if not would they accept a prescription to buy a box of a 100 or more . Online has good deals and I was going to go that route but it wasnt needed

The only challenge I have from time to time is they dont have the relion insulin so you dont want to get to the bottom of the vial before you buy . Calling the pharmacy may not be a bad idea to save a trip .

[Neirracul]

Re: Newly Diagnosed, having issues

I was able to get some by driving to PA but they still would only sell one box at a time so we will have to figure something else out. And they didn’t have many kinds, had to get the short needle ones because they didn’t sell anything else in the 1/2 or 1/3 cc.

We switched to Novolin after running out of Vetsulin and she’s been on it for about 2 weeks at 12.5 units. Her BG seemed to go high as she was experiencing more periods of lethargy and sleepiness. Has lessened a bit. We were finally able to do a curve today and got the following numbers:

498 - fasting
372
403
564
403
449

It seems like she’s responding more normally to the Novolin even if the action time is only around 10 hours or so. Kind of worried about the BG spike (564) during the period when I would expect the insulin to be working the most. It kind of looks like her early curves of when she was in rebound on the Vetsulin @20 units. What next step do you guys recommend? I recently weighed Maura and she seems to be holding steady at 65 lbs so I thought her dose was already on the low end.

[sibhus]

Re: Newly Diagnosed, having issues

For starters, just make sure your giving your dog an ideal dog food thats not high in carbs and has good fiber.

Im not a vet, but it sounds like your about 5-8 units away from getting your dog in that 150-300 range which is more idealistic. My 85lb husky was swinging if the 400-500s like yours with 30 total units per day as recommended by my vet but now is at 150-280 with 48 total units. I guess if you've done a curve and he is out of rebound, you may want to increase 2 units and see how he responds. I know the vets like to go up one unit at a time but in larger dogs, it rarely makes a difference and you find its more like 3-5 are needed to see any difference.

[jesse girl]

Re: Newly Diagnosed, having issues

I would not focus to much on a higher number as most glucose meters can be off quite a bit at the higher range .

There is no indication of rebound but its difficult to say how your dogs body reacts to injected insulin . Be careful of large dose increases as your pup has already struggled with this and I would think it remembers that shock

Its a slow steady process and it appears that there is an opportunity for a dose increase . One unit would be a conservative approach and do another curve in 5 to 7 days and reevaluate

Taking consideration of physical symptoms is helpful to try to correlate what you are seeing in the curve which is basically just flat at a higher level

Now you could attempt a 2 unit increase and you really have to do a bit more monitoring of blood sugar to the the reaction of that dose increase with correlating physical symptoms

[Riliey and Mo]

Re: Newly Diagnosed, having issues

i think your good to go up 2 units
you must test more at least 4 times a day to catch any low numbers.
it takes a while for changes to level out changes in food 3.25 to 2.50 cups and the change to a more potent nph insulin.
did your vet tell you to keep corn syrup on hand to spread on her gums if she goes low? i still have mine on the kitchen counter

[Neirracul]

Re: Newly Diagnosed, having issues

We decided to split the increase and went up 1.5 units to 14 units. We’ve been testing more during the day, but have not seen any low numbers. We have seen a big increase in high numbers. She hadn’t been hitting 500s on the meter for weeks but now every other test seems to be in the 500s so I’m not sure where that’s coming from. Her energy level has also dropped and she gets too tired to really get her full walk in the morning.

On another note, she’s always been a picky eater and getting her to consistently eat a food was hard but until now she had been eating the ketona for a couple months reliably. Twice in the past week she has refused her breakfast and spent the day laying on the couch very sleepy. Her bg around 9 AM each time was in the 300s and we did not give insulin those two times.

The vet didn’t say anything about keeping corn syrup on hand but we always have honey and pure maple syrup in the house and I’ve read that those are good for hypo as well.

[jesse girl]

Re: Newly Diagnosed, having issues

That is interesting with numbers in the 300s without any insulin but of course no food either but you would still think numbers would be well into the 500s

I only give jesse one meal a day as part of her routine and her morning dose receives a dose of insulin without a meal but I do give her a milk bone . so you can usually give some insulin without food . Usually a quarter of the dose you normally give with food

Now the one meal a day I do for Jesse wasn't because she would not eat 2 meals ( she would and then some ) Its because its the only way i could regulate her blood sugar

Now your dog may have gone through or still is going through a honeymoon period where you still produce some of your own insulin .Usually that is a brief period
That could be the reason you are seeing higher numbers

You do want to the see the reaction to the higher dose and some movement lower . You would also like to see more pep but it usually takes a few days for insulin to settle and see what the response is

[Riliey and Mo]

Re: Newly Diagnosed, having issues

it takes time for changes.

when Riles didnt eat i gave him 1/4 of his insulin dose and if he ate 1/2 food i gave the recommended half of his dose.

can you try a topper on his food like salmon or cheese