Soaphie the sophisticated is an angel October 29, 2015

[Soaphie & Sydney's Mom]

Re: Soaphie

Yesterdays appt went very very well. We are starting at 10/10 NPH and will adjust from there. This morning her BG was 263.

Thank you everyone!

Tami

[Dollydog]

Re: Soaphie

Hi Tami,
I've really appreciated reading this part of your thread as I want to change Lady to a human insulin. (Will check with our pharmacist to see if NPH is available here before I discuss it further with the vet.)
Lady is approximately 15lbs and gets 16iu's of Caninsulin twice a day....haven't checked her in the last week so don't know if it's made much of a difference.
Wishing you all the best with the transition and I'll be checking back often to see how you make out,
Jo-Ann & Lady

[k9diabetes]

Re: Soaphie

Everything's crossed here in hopes that Soaphie gets nice level curves from the NPH!

Even just from the standpoint of working with a large dog, it's nice to use NPH instead.

Natalie

[eyelostit]

Re: Soaphie

I think it will all go well for you, seems most owners do the switch and have better results.

Take care all will be OK

[k9diabetes]

Re: Soaphie

I see from posts elsewhere that Soaphie seems tired despite good blood sugar levels. Keep an eye on this as Chris was allergic to the protamine in NPH and he showed it by being lethargic and tired, especially when walking. Once he was on all NPH, he couldn't walk to the end of the block.

Sounds, too, like Soaphie may be one of those dogs whose blood sugar bounces around regardless of the insulin. Time will tell. Chris was not all that stable on a dose of insulin and we varied his number of units periodically. His was kind of a wave of rolling changings.

[Soaphie & Sydney's Mom]

Re: Soaphie

Gosh - I sure hope she isn't allergic (although - it had crossed my mind). I'm hoping when we are back to our normal schedules next week that "all will be well". It's funny - our other dog (non-diabetic), sleeps more than Soaphie and I don't second guess any of her movements. Ugh.

[k9diabetes]

Re: Soaphie

I always think of it in terms of what's "normal" for Soaphie or for Chris.

Chris' sudden inability to walk to the end of the block came on fairly abruptly and at first we thought it was arthritis. But then I stumbled on some discussion of what's called "Stiff Man Syndrome" in people while researching his problems and several diabetic people posted that they resolved extreme stiffness and soreness instantly by getting off of NPH!

So we took Chris off the NPH and within about 48 hours he was back to normal.

If I hadn't read about Stiff Man Syndrome, I probably would never have figured it out.

Does Soaphie tend to be allergic to things?

Natalie

[k9diabetes]

Re: Soaphie

I see she does have allergy tendencies, at least toward food.

You can wait and see how she does - just wanted to put it out there as a possibility.

I still think Soaphie might wind up being one of those dogs whose blood sugar bounces around. (Sorry!) If she's not allergic to the NPH, you could settle on a sort of "basal" dose of NPH and then treat high blood sugars with a bit of Regular.

Judging from the numbers you've seen so far (posted elsewhere), the 10 units is keeping her in a good range overall - the low day only went into the low 100s and the higher readings in the 300s but most readings in the 200s. If Soaphie's gonna be a "bouncer", this is the kind of range you would aim for - where the low days aren't dangerously low. This would be good safe regulation for Soaphie if she continues this pattern of periodic unexpected low days.

Natalie

[Soaphie & Sydney's Mom]

Re: Soaphie

Natalie -

I've been reading and re-reading your case study on Chris throughout the weekend. What a great summary of "the story" - so very helpful.

Here is my question for the group:

Soaphie has been on NPH since last Monday night, we are doing a full curve today. She has been very lethargic. I'm unsure if it's due to high BG's or if she is allergic to NPH like Chris was. We'll give it more time of course, but play along with my scenario below - want your experienced opinions:

So for a moment - let's assume she is allergic to NPH and let's assume that we aren't able to do 4 shots of R throughout the day due to work schedules etc......any thoughts as to what our other options would be? Knowing that Vetsulin gave us way too many lows and it not an option?

Thank you all!!!!

Tami & Soapher

[We Hope]

Re: Soaphie

Soaphie has just started with NPH, so it will take more time than this to try to find her "right" dose, so it's sort of borrowing trouble right now to be assuming she has problems with either the protamine suspension or the different preservatives of the NPH.

You probably will be seeing some higher numbers right now until you learn what the right number of units for Soaphie are.

You'd be better off assuming that you're not at the correct dosage of the NPH at this point, rather than that Soaphie can't tolerate it.

When we were forced to take Lucky from pork Lente to pork NPH because Lilly had discontinued the pork Lente and we were in the process of waiting for our IND (Investigational New Drug)-Personal Use paperwork to be approved by FDA, he used the pork NPH for a bit more than 2 months.

Lucky was happy, healthy, active, and doing very well with all aspects while he was using the Lilly pork Lente insulin. Even though both were made from pork, we found that it took more insulin to control his blood glucose with the pork NPH than it did with the pork Lente.

Protamine is a protein, just as insulin is, and this means there is a possibility when you have immune-mediated reactions (as we did to both human and beef insulins), the same thing can happen with the protamine suspension--that the body begins attacking that, just as it did the insulins other than pork.

Lucky's system was going after the salmon-based protamine too. The only thing he liked about pork NPH insulin was that the insulin itself was made from pork. This meant that his bg's were not out of control, but it was taking more pork NPH insulin to keep them in control than it was of the pork Lente, which has no protamine in its suspension.

After a little more than 2 months on it, this was beginning to interfere with his blood glucose control even more.

He had other issues with the phenol and metacresol preservatives of the NPH; Lente insulins have only one preservative in them and that's methylparaben. The preservatives which are used in both NPH and R insulin cannot be used in the production of Lente as they will destroy the Lente type insulin.

Lucky was extremely lethargic, sleeping most of the time while using pork NPH. He never had neuropathy, no matter how high his blood glucose was before we got control of it, but he developed neuropathy while on the pork NPH.

His skin and coat were extremely dry--his fur looked dull, dry and lifeless; the coat was also very thin. He also began having a problem with his eyes becoming constantly irritated and watery. None of this was happening while he was on pork Lente insulin.

I could see him begin to improve with all of this from the first shot of Caninsulin/Vetsulin. Within two weeks of switching to it, all of his complications were gone. He even decided to re-grow the winter coat he'd grown while using NPH insulin, and he shed every last hair of it. The new fur was as it always was--thick, shiny, and healthy. His neuropathy resolved, his eyes were no longer irritated and he was his normal, happy active self once again.

So let's not go any further ahead with the thought that Soaphie may not be doing well with the NPH for now--give it a chance.

Kathy

[Soaphie & Sydney's Mom]

Re: Soaphie

So is it "normal" (per se - whatever "normal" is) to see the lethargy when switching insulins?

I agree with you that it's too soon to tell - but I want to do the research so we don't go another 5 months (like we did with Vetsulin) before making a switch.

She just has no energy at all...

[Soaphie & Sydney's Mom]

Re: Soaphie

So far today:

8:00 a.m. 352
10:00 a.m. 272
11:00 a.m. 286
12:10 p.m. 326
1:21 p.m. 330

[We Hope]

Re: Soaphie

Sorry--my computer decided I was finished posting before I really was.

What needs to be sorted out here and it's still too early in the NPH game to do that is whether Soaphie's lethargy stems from not yet having her bg's controlled by the right amount of units of NPH or whether this comes from something in the insulin itself.

We knew it was the insulin suspension and preservatives with Lucky because we had gotten his bg's under control with it. We also know it wasn't the insulin itself because pork insulin was the only one he responded to.

Lucky was also just the opposite when he had high bg's--they made him hyperactive instead of lethargic--like a little kid on a "sugar buzz" who's had way too much candy. So for Lucky, he didn't become languid at all when we tried the human and beef insulins--his immune system simply destroyed them before they could do anything about controlling his blood glucose and he went around on his "sugar buzz". He only became lethargic after going onto the pork NPH and that disappeared rapidly once he was back on pork Lente insulin.

Natalie's Chris had no problems with the human insulin itself, and no problems with the preservative metacresol, which is also in R insulin. His problems stemmed from the protamine suspension of the NPH and likely from the addition of the phenol that is also used to preserve NPH.

Soaphie most likely will need to have her NPH increased--it's very rare that you hit on the right dose the first time when you start an insulin.

Kathy

[We Hope]

Re: Soaphie

Not sure this is helpful, but FWIW--

The U 100 insulins will take somewhat longer with onset, peak and last longer than U 40 ones do; the NPH you're using is a U 100 insulin while Vetsulin is a U 40 one.

There is one amino acid difference between human insulin and pork/canine insulin--the difference is that of the B-30 position of that chain.

When you have amino acid differences between the insulin you're using and the one your pancreas made when it was working properly, this creates some insulin resistance. The resistance doesn't always have to be the type that interferes with diabetes control--what it can do is to make the insulin's onset and peak slower, as well as increase its duration.

People who used bovine ultralente insulin as their basal, or body's basic needs, not considering food, found all of this to be positives for them; there are 3 amino acid differences between bovine and human insulin as you can see on the graphic above. Bovine ultralente used in a human being lasts longer than Lantus.

Not long after Lucky was diagnosed with diabetes, he had a cyst near his tail open up. We treated it and there was no infection, but when the fur in that area grew back, it looked slightly different than the rest of him. The only people who would notice something like this would be John and myself--others wouldn't have seen the difference.

Even after Lucky got onto U 100 pork Lente insulin from Lilly, that spot didn't change--when he shed, it still looked slightly different. After going onto the U 40 pork Lente from Intervet and shedding the terrible winter coat he'd grown when using pork NPH, that funny spot was gone forever. I couldn't find it no matter how hard I looked and neither could the professional eyes of John.

When using U 100 pork Lente, Lucky's bg's were in the low 100 range--very nice, steady and would be considered in the normal blood glucose range for someone without diabetes. After regulating on Caninsulin/Vetsulin, he was in the 85 range and just as nice and steady. So for Lucky, having the U 40 insulin with a faster onset than the same U 100 was a plus, as his body was using the insulin better than it was the Lily pork Lente.

Kathy

[k9diabetes]

Re: Soaphie

I am concerned because Soaphie's BG has been mostly in the 200s while on NPH, which is really pretty good - I'm doubtful that the lethargic behavior is a result of high blood sugar, especially since its onset coincides exactly with introduction of NPH.

Chris went on to NPH gradually so the stiffness came on gradually as well.

I wouldn't want to up the dose much right now given that she had a the better part of a day in the low 100s. Here's her numbers collected from your posts at the CDMB:

NPH was started on Monday 22nd evening dose.

"Officially" was on 15/15 Vetsulin (but I had decreased it over the last week or so) and are now on 10/10 NPH.

12.23 - first day of 10/10 NPH - mid-200s on 3-4 readings, 263 at breakfast

12.25 - Every BG I have taken has been right around the mid 200's

12.26 - 360 before eating breakfast and 380 5.5 hours later.
12.26 - 11.5 hours 132 predinner
12.26 - 4 hours after insulin shot - 121 BG. Fed her a snack.

12.27 - This morning she was at 271 so that's good.

What you can do to sort out if it is the NPH is to, temporarily, go back to the Vetsulin. That's the most straightforward way to find out if NPH is a problem for Soaphie.

If she perks up quickly by switching back to Vetsulin, then I'd say you have your answer. If not, then you know it's something else bothering her and you can go back to NPH.

Chris had the same response to a food allergy by the way.

In terms of what other insulins you can use, there are not a lot of other choices. Regular can sometimes be used three times a day rather than four. Lantus is another possibility. Levemir is likely out if NPH is a problem because Levemir also has protamine in it.

I'd suggest doing a quick switch back to Vetsulin at the same number of units you were giving of it or even a little less - not necessarily aiming for perfect blood sugar control, just for the NPH to clear her system - give it 48 hours and see what you get.

If you're "lucky" the lethargy won't change... and I say "lucky" only in that your insulin alternatives are limited. Because if switching back to Vetsulin doesn't change her lethargic behavior, you will have to look for something else as the cause and that's scarier than an insulin preparation allergy.

Have there been any other changes at the same time?

Food, supplements, meds, etc.?

Any other change made at the same time could be at the root of the problem.

Natalie