meal pattern-diet with vetsulin

[diethelp]

Hi K9 Forum,
I am brand new to forum.

Wondering if anyone can help me with diet questions for my dog Buster on vetsulin twice a day. He was diagnosed 1 month ago. He lost weight and I can not get weight on him. Went to vet 1 week ago and we increased insulin to 9U and she said "let him eat whatever he wants and come back in two weeks --do not take sugars until day before apt with 12 hour curve".

I have increased his food and feed the same homemade diet recipe and teh same quantity at same times 7AM, 1PM, 7PM, and before bed at 10P. Today I decided I should take his blood sugar --it was 477 at 1 hour after afternoon snack and then 416 at 4 hours after snack.

Should I feed him twice or four times per day? Does he need more insulin or less food? I wonder if he is not gaining weight because he has high blood sugar or is it because he needs more insulin?

Any help much appreciated.

Teri and Buster

[We Hope]

Re: meal pattern-diet with vetsulin

Welcome Teri and Buster!

Often there's weight loss at the time of diagnosis--sometimes quite a bit of weight has been lost. The good news is that as Buster gets better blood glucose control/closer to being regulated, he will start picking up the lost weight.

The body needs insulin to be able to use the food you eat for fuel. Without enough insulin it can't do that and sometimes starts using other things like fat and muscle to burn as fuel instead of the glucose made by the food you eat; it's unable to use that glucose for energy as intended.

This is where you see the glucose in the blood and in the urine because it's not being used for the body's source of energy.

The usual feeding pattern would be meals 12 hours apart, same amount of food in each one, given just before the insulin shot. Some people find that going with 3 or 4 smaller meals works best for their dog because of post-meal bg spikes or lows from the insulin--it depends on the dog.

As the blood glucose control gets better and you get closer to or at regulation, the body is once again able to use the glucose the eaten food creates as its energy source; what it doesn't need for energy it's again able to store as fat.

You may decide to use a prescription or non-prescription food that's high in fiber because it helps with glucose absorption; it can also reduce insulin needs because of this:

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

"The aim of dietary change is to improve glycemic regulation.

"A diet must provide all the nutritional needs of patients and should minimize post-prandial fluctuation in glucose concentrations.

"The essential features of the diet should be:

"Consistent from day-to-day (to prevent unnecessary alterations in insulin requirement).
"High in complex carbohydrates so that glucose is released in a steady fashion from the gut.
"Given so that glucose absorption from the gut coincides with peak action of administered insulin.
"Of the correct caloric value to take diabetes weight to optimal weight.
"Fat-restricted."

Your vet is right when saying that Buster should eat what he wants--the important point is that he keeps eating so he can have the full prescribed doses of insulin:

http://veterinarycalendar.dvm360.com...09%09&pageID=8

Diabetes mellitus (Proceedings)
Apr 1, 2009
By: William D. Schall, DVM, DACVIM
CVC PROCEEDINGS
DVM 360

"The consequences of feeding a non-prescription diabetes diet are usually minimal as the increased dose of required insulin is seldom greater that 2-4%.

"In the overall context of initial home insulin administration, efforts should be made to keep dogs eating even if the food type and feeding schedule is not textbook optimized."

Even though it sounds like you're already doing blood testing at home, I hope you're checking Buster's urine for ketones; anything over a trace amount can be a medical emergency-

http://k9diabetes.com/forum/showthread.php?t=958

Ketostix check urine only for ketones--Ketodiastix check urine for both ketones and glucose. They can be purchased at any pharmacy; you might need to ask the pharmacist for them (behind the counter to prevent theft).

Since Buster is still in the 400's, it sure looks like he will need to have his insulin increased. Is there any way you could move up your vet appointment to speed up the increase? Insulin can be increased much sooner than 2 weeks when needed:

http://www.childrenwithdiabetes.com/...as_insulin.pdf

Insulin Dependent Diabetes in Children, Adolescents and Adults-Dr. Ragnar Hanas

Page 10

"The size of the insulin depot makes it necessary to allow 2-5 days of adjustment before achieving a new equilibrium."

What she's saying is that it takes at least 2-5 days to see the full effects of an insulin increase. You shouldn't be increasing faster than that but it's possible to increase if needed much sooner than 2 weeks.

I think Buster will start putting his weight back on as soon as his blood glucose readings are better.

HTH!

Kathy

[eyelostit]

Re: meal pattern-diet with vetsulin

Was it the vets suggestion to feed 4 times a day?

Dolly and Niki

[diethelp]

Re: meal pattern-diet with vetsulin

Thank you Kathy for your detailed response, this was very helpful and so were the links in your response.

I am wondering how to do a urine test.

The reason I feed 4 times a day because on the vetsulin site it said this was optimal. But I wonder if the duration of vetsulin is shorter in my dog and wonder if he should get the mid day meal and before bed meal or instead just a larger meal twice a day. My vet did not recommend anything really.

Teri

[We Hope]

Re: meal pattern-diet with vetsulin

Teri,

Ketostix give results in 15 seconds after use and Ketodiastix in 30 seconds. Both have color coded results charts on the bottles and after you've timed your strip, you compare the color or colors (Ketodiastix has two--a section for glucose and a section for ketones) of the chart on the bottle to the strip you've just used.



(Posting the smaller version of the photo--the larger one is at the link below.)

http://images2.wikia.nocookie.net/di.../Ketonuria.jpg

Here you see someone using Ketostix and comparing the test results to the chart on the bottle. The test shown is not good news--the ketones are reading 80 or Large--this is a medical emergency.

http://diabetesindogs.wikia.com/wiki...lucose_testing

http://diabetesindogs.wikia.com/wiki/Ketoacidosis

Sometimes getting a sample of urine to test is the hard part--here are our members offering some advice on how to do that:

http://k9diabetes.com/forum/showthread.php?t=1007

Most dogs are placed on a two meals a day plan--the day's total portion of food divided in half and served 12 hours apart--just before the insulin shot. There are some people who need to go with 3 or 4 smaller meals a day because they have lows they are feeding this way to correct or because the dog has a large post-meal bg spike and the smaller meals lessen that.

Sometimes feeding more than twice a day means the food can interfere with the insulin's action. My little guy was regulated tightly on Vetsulin and getting two meals a day. When he had a minor colitis bout, we temporarily went to three meals a day because of that; it interfered with the action of his insulin. Getting back to the two meals a day when the colitis was over let him get right back to his tight regulation.

Doing a curve would show you how the insulin and feeding times are working for Buster; he might be getting the right amount of insulin now but the meals which aren't given with the insulin shot might be the problem--a curve would tell us that. This wouldn't be a duration problem but a problem of food and insulin timing. You'll know also just how long the insulin works for Buster when a curve is done.

Kathy

[k9diabetes]

Re: meal pattern-diet with vetsulin

Hi Teri,

Can you tell us more about Buster?

What breed is he and how much does he weigh?

Also, how has his blood sugar been monitored and what have the levels of his blood sugar been before the food was increased?

I haven't had a chance to read the replies below, but just wanted to summarize that gaining weight in a diabetic dog requires both enough insulin to let them make use of the food they eat and enough calories so that they can, with insulin, start to put weight back on. Right now he definitely does not have enough insulin to go with all of the food he's getting.

Although the Vetsulin sites often suggested a double peak of the insulin, it doesn't necessarily turn out that way.

So I'm curious if you have done any curves while he was fed four times a day. If so, could you post the results?

Definitely check for ketones with blood sugar at 400-500 and let us know what his blood sugar has been. If it's staying in the 400s all the time, I would want to increase his insulin sooner than two weeks. Question is whether it's always that high or is only that high right after eating.

Natalie

[diethelp]

Re: meal pattern-diet with vetsulin

First of all, thank you everyone for all your help! I can't tell you how much it means to have others who are going through this. It is quite difficult and it turns your life upside down!! My vet's advice on diet is really general and I do not feel confident with it--see her comments below (I would love to have feed back on her advice).

Buster is an 11 year old Australian Shepard. As I mentioned before he needs to gain weight. I am feeding him a homemade diet of lamb, rice, and green beans with 1-1/2 tsp canola oil or butter added each feeding (it is in a ratio of 2 cup lamb, 3 cup brown rice, 1/2 cup gr beans). He gets vitamins and fish oil too. His meal pattern is this: 7:30AM and 7:30 PM 9unit insulin, 2-1/2 cup, 1P 1-1/2 cup, before bed 1 cup. He gets a big walk in AM at 8:30.

Yesterday I took blood sugars at 10:30A--133, 12:30P--177, 2PM--473, 4:30PM--416

Today I am going to do a curve. His fasting blood sugar at 6:30 AM was 313, at 9:30 after his walk it was down to 106. I decided to give him a 1/2 cup food at 10 as I was worried about low sugar. This is where I am now.

Here is my vet's advice: "We need a full curve before we make adjustments. I need to know the time of insulin administration and then need a 12 hour curve, starting with a pre-insulin glucose level. It may be that the dose is too high and we are having a somogyi effect. Increasing the dose based on your numbers could be detrimental. Please relax, most dogs go into the 400’s and do not all get cataracts while we get the insulin adjusted. The most important question is: how is he feeling? You are correct that insulin duration is variable, but without a pre-insulin glucose and a time of administration, I cannot tell you duration.

You do not have to do insulin 12 hours apart exactly, but I like it around that. Please remember that dogs are NOT people and we are not dosing them based on activity, or food intake"

I will purchase ketone strips today.

THANK YOU EVERYONE!!!!!!!!!!!!!!!!!

[diethelp]

Re: meal pattern-diet with vetsulin

One more thing--Natalie--you asked his weight--buster weighs 53#. I am really hopeful that Buster could be regulated like your little guy with 2 feedings!!

I am wondering, if I feed him with the two meals--would I increase the quantity to say 3 cups?

Thanks Again for all you help!

[We Hope]

Re: meal pattern-diet with vetsulin

Teri,

First of all, exercise (walking for a bit) generally lowers blood glucose; this is why making a commitment to a sensible, regular exercise program is said over and over to people with diabetes of both types--it can help keep your blood glucose under control. The time not to do something like this is when the insulin's "peaking", or is hardest at work. Having that work at its maximum and the additional lowering of the blood glucose from the exercise can mean having a low or a hypo.

From the numbers you've just posted, it looks to me like the two "extra" meals might be what's keeping Buster's blood glucose up. He looks very good after he gets his breakfast and insulin until about 2 PM--this is when "lunch" is starting to digest. Also think Buster wouldn't start the day at 313 without the "bedtime snack".

Buster's currently getting a total of 5 cups of food--how much was he being fed before the diabetes diagnosis? I don't think I'd increase his food--might leave the amount as is--2 1/2 cups per meal--or even cut it a bit to 2 cups at breakfast and dinner.

About the vet's advice:

When we started working with Lucky, one of the things John told me was that consistency can be your best friend--the same amount of food at the same time and the same number of units of insulin just after.

Before Vetsulin was approved in the US and when he was first diagnosed, we learned Lucky would only respond to pork insulin; anything else would be destroyed by his immune system before it could really have a chance to lower his bg's. At the time Lilly produced an insulin just like Vetsulin in everything but the strength; Lucky regulated well and quickly on their Iletin II Lente.

Not long after that, Lilly decided to stop making this insulin, and we got 2 vials of it which weren't 100% potent. The pharmacies didn't stock this insulin--they needed to order it for you. This was a weekend and no chance to place an order until Monday. In the meantime we decided to see if the older vial we were going to discard because it was starting to lose potency was stronger than the insulin in the brand new vials and put Lucky back onto the old vial.

It was (the new ones tested at about 40-50% potent) but we had no idea just how much potency was still in the old vial. Raising the insulin dose would have meant a possible hypo so we had to stay at the same dose as if the insulin was 100% potent.

Lucky's bg's were high enough that he had a visible post-meal spike (panting) 2 hours after a meal. Being consistent with the amount of his food, the amount of his insulin and doing this every 12 hours got his bg's down over the weekend.

So there's a lot to be said for consistency.

Am going to disagree with the statement about dogs, people, activity and food because if both dogs and people with diabetes didn't consider these factors, no one would have diabetes control.

With both, generally the more food they eat, the more insulin that's needed to "cover" that food to allow the body to process it properly. In both, too much insulin and not enough food means going low or having a hypo, just the same as the reverse means higher bg's to both.

If both people and dogs with diabetes suddenly have too much unplanned activity, they can both have lows or hypos and if they both become total "couch potatoes", it's usually going to mean high bg's because of it.

The sooner there's a safe plan for any needed insulin increases in effect, the better chance that cataracts and other diabetes problems stay away. The aim is for getting regulated as quickly as possible but doing that in a safe manner (no huge insulin increases at one time or increasing the dosage too rapidly). When we initially were working with Lucky, there were times when his insulin was increased after 3 days (this was before we had him on pork insulin) because his bg's just weren't responding to either human or beef insulin.

Kathy

[k9diabetes]

Re: meal pattern-diet with vetsulin

Just have a moment... I'm anxious to see the results of the curve...

If you cut back to two meals a day, you take the total amount of food he was eating each day... looks like 7.5 cups of food per day (that seems like a lot! but it depends on how much is vegies) and divide that into two meals, so about 3.75 cups if two meals.

My guess, as Kathy mentioned, is that the afternoon snacks are just washing away cuz not much insulin to go with them. You might see him gain weight on his old food amount if fed twice a day.

9 units is not a very big dose so might not be enough to go with so much food. If you cut back to two meals a day, those extra calories given with the insulin would likely flatten out the difference between the highest and lowest blood sugar. So more level numbers but higher, which would allow you to increase the insulin.

Natalie