Angel Scooter... August 31, 2013

[CraigM]

Re: Surgery on a diabetic dog, Possible Somogyi

You are correct that is the most accurate.... however, if you read Annie Getting too Smart thread, Craig has done some tests where you may use the Abbott's FreeStyle Freedom strips in the AlphaTrak2.... After you feel more comfortable with the readings, you may want to do some side by side comparisons. I have some strips on order, and will be doing some tests as well, and see how accurate they are with the AlphaTrak2 meter.

Barb

My comparison of AlphaTrak2 and FreeStyle Lite test strips can be found in post 977 in http://www.k9diabetes.com/forum/show...?t=1637&page=2

Of course it would be best for you to do your own comparison. Here is a picture of the FreeStyle Lite strips that I'm using: https://www.dropbox.com/s/sqpa5h8z4c...-26_121134.png

Craig

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

My comparison of AlphaTrak2 and FreeStyle Lite test strips can be found in post 977 in http://www.k9diabetes.com/forum/show...?t=1637&page=2

Of course it would be best for you to do your own comparison. Here is a picture of the FreeStyle Lite strips that I'm using: https://www.dropbox.com/s/sqpa5h8z4c...-26_121134.png

Craig

Thanks, Craig. I had read here that others were using Freestyle and finding a factor to calibrate w/ Alphatrack. My husband is a pharmacist and he said that it is awful that the method for checking blood is so archaic. Seriously, how do people do this all day long with their animals? Easy to get human blood, but I just don't have 'the touch'. I felt the same way (sort of) when I learned to give two shots and now that is a breeze, but this is very different.

I don't have time to do get different strips and work on calibrating, so i will most likely eat the costs of the AlphaTrack sticks. I actually used over 25 yesterday (my first day of testing) because I didn't catch on. But today, I've tested 3 times and did a little better. I actually went back to the vet and had the tech show me again. It was a different tech who had a much better method of teaching me. He even said he would come to my house and show me during his lunch! How about he just move in and I will take a vacation?

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

My dog, Jeb, had a seizure just over a year ago following a 1500 mile road trip. We never knew what caused it because there were so many variables (routine, exercise, temperature, humidity, elevation, etc.). I knew enough, barely, to put pancake syrup in his mouth and he came out of it. I know what you’re saying when you talk about how frightening it is. The vet cut his dosage more than in half, from 10.5 to 5. I learned to test (that’s another long story) and we increased gradually over a period of several months to our current 9.5. A very wise woman, who is a member of this forum, told me “Low and Slow,” and I believe that advice probably saved Jeb’s life. We increased his dosage in .5 and sometimes .25 increments and waited at least 2 weeks after each change to give his body time to become accustomed to the increase. We found that his bg increased for 2-3 days after every change before settling into a pattern. He weighs 53 lbs. but is sensitive to even tiny changes. It’s been a long haul, but he’s doing very well now. Every dog is different, but for us, this is what has worked. Best of luck and hugs to you and Scooter.

We took Scooter on a road trip (8 hours one way) over a four day period back in November and he ended up at the vet while on the trip because I saw blood in his urine. He was x-rayed, looking for stones (none seen) urine tested for WBC...nothing. They gave him an anti-biotic and by the time we got home he was back to normal. I think it was the stress, but it was a mystery to the vet. That was 8 months ago and I think unrelated to this hypo incident.

I hope others will post what preceded a hypo incident their dog had so I can try to never have it happen again. I think it was either (as someone here said) pain from the stones, not eating day of surgery (and getting 1/2 dose) and not being monitored after the surgeon randomly changed the amount of food and insulin. I should have questioned this, but I was so worried about the stone removal, I just went along with his protocol. He did the surgery at 6:00 am and it was a frantic time. I could kick myself for not thinking more about what we were doing...and, why he did it. I told him I was feeding 3/4 cup of WD twice a day, giving 8 units 2x's a day. Other than occasional vomiting (when I didn't feed him WHEN HE WANTED ME TO!) he was perfect. He said he calculated what his caloric intake 'should' be based on the chart, but that had never been enough food for him. Oh...I could go on and on. I hope to figure out why this happened.

Thanks, all for taking the time to help.

[CraigM]

Re: Surgery on a diabetic dog, Possible Somogyi

Thanks, Craig. I had read here that others were using Freestyle and finding a factor to calibrate w/ Alphatrack. My husband is a pharmacist and he said that it is awful that the method for checking blood is so archaic. Seriously, how do people do this all day long with their animals? Easy to get human blood, but I just don't have 'the touch'. I felt the same way (sort of) when I learned to give two shots and now that is a breeze, but this is very different.

I don't have time to do get different strips and work on calibrating, so i will most likely eat the costs of the AlphaTrack sticks. I actually used over 25 yesterday (my first day of testing) because I didn't catch on. But today, I've tested 3 times and did a little better. I actually went back to the vet and had the tech show me again. It was a different tech who had a much better method of teaching me. He even said he would come to my house and show me during his lunch! How about he just move in and I will take a vacation?

You might have misunderstood what we are doing with the FreeStyle Lite test strips. They seem to be identical to the AlphaTrak2 strips, no conversion required. The theory is that Abbott is making the same strip, but packaging them under two different names. http://www.amazon.com/Freestyle-Lite...te+test+strips

My tests have been with the newer style "butterfly" strips in the yellow box, and not the older style in the blue box.

Sorry I can't help with getting a lip sample, I've only used the ear for Annie. I don't fully insert the test strip until I see a usable droplet. Guess that would be harder on the lip because they would be trying to lick the drop

Craig

[amydunn19]

Re: Surgery on a diabetic dog, Possible Somogyi

My dog has had a few hypo episodes. The first two episodes came after a pancreatitis attack, when she was refusing to eat. I was not testing her myself because they had told me it wasn't necessary. My vet at the time advised me that she must eat the w/d and nothing else and that she would eat it when she got hungry enough. She was an idiot. I left that practice without looking back.

Another hypo episode occurred when her dermatologist put her on a limited ingredient food trial with the rabbit and potato prescription food. This food barely raised her bg at all and didn't stay in her system any time at all either. I was totally unprepared for the drastic drop this food would cause. Lesson learned about ingredients in new dog foods.

A couple of other times came out of the blue. Literally I did not see them coming but I keep Maggie on pretty tight regulation - too tight at times. Even testing, sometimes they drop without a real concrete reason. I would say the safest thing is to keep the bg at a higher safer level. It is a trade off - I have Maggie with me or someone who has diabetes experience every second of the day so I keep her lower than I would if I couldn't monitor her most of the day.

Surgery wise, I always feed Maggie half of her meal (per my vet's instructions) and give half insulin. The fact she had a few hypo episodes before made him feel like it would be unsafe for her not to eat a little in case something delayed her surgery during the morning. Most vets will not know how the dog will react during surgery until they actually have some experience with that particular dog having a surgical procedure. They are all different.

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

My dog has had a few hypo episodes. The first two episodes came after a pancreatitis attack, when she was refusing to eat. I was not testing her myself because they had told me it wasn't necessary. My vet at the time advised me that she must eat the w/d and nothing else and that she would eat it when she got hungry enough. She was an idiot. I left that practice without looking back.

Another hypo episode occurred when her dermatologist put her on a limited ingredient food trial with the rabbit and potato prescription food. This food barely raised her bg at all and didn't stay in her system any time at all either. I was totally unprepared for the drastic drop this food would cause. Lesson learned about ingredients in new dog foods.

A couple of other times came out of the blue. Literally I did not see them coming but I keep Maggie on pretty tight regulation - too tight at times. Even testing, sometimes they drop without a real concrete reason. I would say the safest thing is to keep the bg at a higher safer level. It is a trade off - I have Maggie with me or someone who has diabetes experience every second of the day so I keep her lower than I would if I couldn't monitor her most of the day.

Surgery wise, I always feed Maggie half of her meal (per my vet's instructions) and give half insulin. The fact she had a few hypo episodes before made him feel like it would be unsafe for her not to eat a little in case something delayed her surgery during the morning. Most vets will not know how the dog will react during surgery until they actually have some experience with that particular dog having a surgical procedure. They are all different.

WOW~This is EXACTLY what I wanted to hear...a story like this. I just spoke with the vet (for an hour, really trying,) and he suspects cushings as his number one, then insulinoma (or pancreatoma or something). I listened, my husband (a pharmacist) listened. I gave him the article 'Chris' story' from our support group, so we talked about using two types of insulin like they used for 'Chris'. Here is what I think...may be worth 2 cents, but here goes: He was PERFECT before the surgery. Yes, I didn't curve him, yes I didn't do regular testing, but he was fine. He didn't eat for 36 hours and had 4 units morning of surgery (half his dose). The doc lowered his food and insulin going forward. I think because we went from 3/4 cup 2x's daily to 1/2 cup and from 8 units to 6 units it created this problem.

After the hypo incident, doc put him back to 2 units and we are going from there.

I know I can't just increase him and it has to be done gradually. I have increased his food back to 3/4 cup because he is STARVING. I still have him on 2 units, but am going to test and see where his numbers go.

The vet talked about what he suspects and he may be right...maybe a coincidence...but after reading your experience...almost identical to mine...I'm convinced we can pull out of this and there isn't an underlying condition. It would be too much of a coincidence (hope, hope, hope).

Thank you ever so much for writing because I suspected that there was someone on this site who had gone through a similar situation and it gives me hope that I can think of this as possibly starting over just like when he was diagnosed. Never, ever want to witness a hypo situation again. Thank so much, Maggies mom!

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

You might have misunderstood what we are doing with the FreeStyle Lite test strips. They seem to be identical to the AlphaTrak2 strips, no conversion required. The theory is that Abbott is making the same strip, but packaging them under two different names. http://www.amazon.com/Freestyle-Lite...te+test+strips

My tests have been with the newer style "butterfly" strips in the yellow box, and not the older style in the blue box.

Sorry I can't help with getting a lip sample, I've only used the ear for Annie. I don't fully insert the test strip until I see a usable droplet. Guess that would be harder on the lip because they would be trying to lick the drop

Craig

Hi ya, Craig...those are still pricey. Do you get a deal somewhere? I got 50 Alphatrak for $69.00 from the vet.

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

My dog has had a few hypo episodes. The first two episodes came after a pancreatitis attack, when she was refusing to eat. I was not testing her myself because they had told me it wasn't necessary. My vet at the time advised me that she must eat the w/d and nothing else and that she would eat it when she got hungry enough. She was an idiot. I left that practice without looking back.

Another hypo episode occurred when her dermatologist put her on a limited ingredient food trial with the rabbit and potato prescription food. This food barely raised her bg at all and didn't stay in her system any time at all either. I was totally unprepared for the drastic drop this food would cause. Lesson learned about ingredients in new dog foods.

A couple of other times came out of the blue. Literally I did not see them coming but I keep Maggie on pretty tight regulation - too tight at times. Even testing, sometimes they drop without a real concrete reason. I would say the safest thing is to keep the bg at a higher safer level. It is a trade off - I have Maggie with me or someone who has diabetes experience every second of the day so I keep her lower than I would if I couldn't monitor her most of the day.

Surgery wise, I always feed Maggie half of her meal (per my vet's instructions) and give half insulin. The fact she had a few hypo episodes before made him feel like it would be unsafe for her not to eat a little in case something delayed her surgery during the morning. Most vets will not know how the dog will react during surgery until they actually have some experience with that particular dog having a surgical procedure. They are all different.

I forgot to ask...so you feed morning of surgery? My vet said no food after midnight and never withhold water (in the past most have told me to pick up food and water in the past when my dog(s) were healthy). I wanted to do that, but I never asked because I thought it was a no-no and thought to be too dangerous. But, I think precautions can be taken in these instances, but I don't know. Wow...you have given me so much to think about.

[CraigM]

Re: Surgery on a diabetic dog, Possible Somogyi

Hi ya, Craig...those are still pricey. Do you get a deal somewhere? I got 50 Alphatrak for $69.00 from the vet.

Yea, but 100 for $63 is better than 50 for $69

Craig

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

Yea, but 100 for $63 is better than 50 for $69

Craig

Duh...yes, I am so exhausted...thanks for clarifying. Husband said I could find the strips at a drug store here. I thought I saw them on the amazon site you posted that they were $163.00! Yes, I will go find some tomorrow. I went through so many strips. I find that sometimes I can get enough blood on first poke and then I poke and I quit because I feel like I'm torturing him. I can't do the ears because that is his sensitive spot and he doesn't flinch when I poke his lip. I got a 365 # tonight and frankly I can live with that. It was 4 hours after 2 units and eating. But, it is a mystery because two weeks ago he was on 8 units (with less food). So the vet is very suspicious there is an underlying condition. My hope is he is wrong. I'm going to test, test, test and raise the dose .5 units at a time, but with the knowledge of the vet. He wants to start doing testing for tumors, pancreas, cushings, etal, and I cannot afford it as I just spent $2400 to date. What does your gut tell you about my situation? Do you think it is a coincidence that the hypo happened after surgery when to date he had been perfect?

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

Yea, but 100 for $63 is better than 50 for $69

Craig

You know what...I just noticed you do a mix of R and N (short and long acting, right?) The vet and I discussed the possibility tonight. But, he seemed to be talking about an insulin that costs hundreds of dollars a bottle. I should go back and read your history with your pup to see how you got to that. We did see some pretty big swings in his last two curves (I posted the numbers previously). Maybe this would be something to consider and an option that would be helpful for us at this time. I can talk to my vet on Monday. He called tonight and spent an hour talking to me about all the possibilities. My mind is spinning and I feel like I had a venti latte (with an extra shot).

[CraigM]

Re: Surgery on a diabetic dog, Possible Somogyi

I'll try to write why I sometimes mix the R & N.

For years I used only "N", but Annie would gain 100+ points after a meal. She would stay high for about 5 hours, and then come down to her lowest reading at around 10-12 hours after the meal / injection (just prior to the next meal / injection). It seems Annie gets her food digested faster than she gets the insulin to work. Every dog / situation is different. Some pups get the insulin working much quicker and their numbers could drop early and rise later in the cycle.

I've been keeping the "N" pretty constant at 8 units, but vary the "R" based on the pre-meal reading. Something like no "R" if below 100, 1/4 unit if between 100-150, 1/2 unit if between 150-250. This works for Annie, but could be very wrong for others.

Your vet might have been thinking of the long lasting Levemir insulin. A few here have tried Levemir with a rapid insulin like Novolog. I understand Levemir is $$$, but seems to be about four times stronger in dogs than NPH insulin and might be something for a dog that is getting a large dosage of "N" to try. Of course if this is true, it wouldn't be very good for a pup that is on a low dosage of "N". I don't have experience with Levemir and will let others comment.

Here is a chart of common insulins in the U.S.. Remember the data is for humans and might be much different in dogs, and different between dogs! http://diabetes.webmd.com/guide/diabetes-types-insulin

Craig

About the FreeStyle Lite test strips. They will probably be $$$ at a local pharmacy, the Internet is our friend for savings.

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

I'll try to write why I sometimes mix the R & N.

For years I used only "N", but Annie would gain 100+ points after a meal. She would stay high for about 5 hours, and then come down to her lowest reading at around 10-12 hours after the meal / injection (just prior to the next meal / injection). It seems Annie gets her food digested faster than she gets the insulin to work. Every dog / situation is different. Some pups get the insulin working much quicker and their numbers could drop early and rise later in the cycle.

I've been keeping the "N" pretty constant at 8 units, but vary the "R" based on the pre-meal reading. Something like no "R" if below 100, 1/4 unit if between 100-150, 1/2 unit if between 150-250. This works for Annie, but could be very wrong for others.

Your vet might have been thinking of the long lasting Levemir insulin. A few here have tried Levemir with a rapid insulin like Novolog. I understand Levemir is $$$, but seems to be about four times stronger in dogs than NPH insulin and might be something for a dog that is getting a large dosage of "N" to try. Of course if this is true, it wouldn't be very good for a pup that is on a low dosage of "N". I don't have experience with Levemir and will let others comment.

Here is a chart of common insulins in the U.S.. Remember the data is for humans and might be much different in dogs, and different between dogs! http://diabetes.webmd.com/guide/diabetes-types-insulin

Craig

About the FreeStyle Lite test strips. They will probably be $$$ at a local pharmacy, the Internet is our friend for savings.

Good morning, Craig and thank you for the explanation...it sounds just like the conversation I had with the vet (except he used words with 4 syllables and I told him to try to stick with monosyllabic ones as I don't have his mental acuity). But, good thing is, my Rx husband was listening and was able to translate for me. ha-ha...we have to keep our sense of humor, right?

Anyway, I tested Scooter last night and he was 356, this morning he was 533. I increased dose from 2 units to 3 units (remember, he was on 8 prior to surgery) so this seems quite low....but just like when I teach people golf my motto is low and slow...but I digress. The vet did find 'Chris' Story' quite unique and I wanted to put that out there to him, and it gave me insight and I wanted him to read the success story they had with Chris.

I am quite concerned (like in Chris' story) that I may be too low and this will cause Scooter to develop cataracts. But, I need to go at this slowly. What is your opinion about increasing dosage? I know when he was first diagnosed, my ORIGINAL vet did once a week testing (no curves) and each Friday we would determine the dose based on one number. With what I know now that seems ridiculous, but it worked...we got lucky. We increased dose by one unit every week and it seems when it was around 90-100 we went back down and stayed there for 2.5 years with periodic testing. What say you?


Also...when you buy the FreeStyle Lite, how do you adjust the meter? (I'm probably not saying it right, but do you put the # of the Freestyle lite bottle in the same way? I'm sorry if that sounds like a stupid question....but...I'm new at this testing thing. It seems so archaic doesn't it...the way we test? So many parts and variables and omg I had no idea. I have diabetic friends and one has a monitor attached and he never complains (unless he gets hungry then he gets pretty testy). I read where the monitors are about $1000 for dogs. Wow. Too bad there isn't an 'app for that'.

Thanks, Eileen

[CraigM]

Re: Surgery on a diabetic dog, Possible Somogyi

I am quite concerned (like in Chris' story) that I may be too low and this will cause Scooter to develop cataracts. But, I need to go at this slowly. What is your opinion about increasing dosage? I know when he was first diagnosed, my ORIGINAL vet did once a week testing (no curves) and each Friday we would determine the dose based on one number. With what I know now that seems ridiculous, but it worked...we got lucky. We increased dose by one unit every week and it seems when it was around 90-100 we went back down and stayed there for 2.5 years with periodic testing. What say you?


Also...when you buy the FreeStyle Lite, how do you adjust the meter? (I'm probably not saying it right, but do you put the # of the Freestyle lite bottle in the same way? I'm sorry if that sounds like a stupid question....but...I'm new at this testing thing. It seems so archaic doesn't it...the way we test? So many parts and variables and omg I had no idea. I have diabetic friends and one has a monitor attached and he never complains (unless he gets hungry then he gets pretty testy). I read where the monitors are about $1000 for dogs. Wow. Too bad there isn't an 'app for that'.

Thanks, Eileen

I'm sure you realize why most of us refrain from suggesting any specific dosage: we are just "parents" like you, but sounds like the one unit increase was needed. I imagine there could be various reasons some vets base dosage changes on a single blood test: parent could become upset with the cost of the full day curve, the dog becoming agitated being locked in a crate / cage for the day and giving false readings, etc.. Most on this forum believe in daily blood testing, and occasional curves done at home, but there are probably tens of thousands of dogs that rely on infrequent testing at the vet clinic and do OK.

About the FreeStyle test strips. I'll copy over my tests I did a week ago from Annie's thread:

"I want to emphasize that the FSL strips are the newer version that mentions the FreeStyle FREEDOM Lite on the box. FSL35 means the AlphaTrak2 was coded to 35. FSL7 means the AlphaTrak2 was coded to 7. (I ignored the code 11 that was marked on the FSL strip container, besides the AT2 meter doesn't have a code 11! Skips from 10 to 12)


AT=95, FSL35=120, FSL7=83
AT=261, FSL35=265, FSL7=234
AT=349, FSL35=352, FSL7=347
AT=221, FSL35=221, FSL7=182
AT=97, FSL35=95, FSL7=88
AT=269, FSL35=292
AT=158, FSL35=155
AT=164, FSL35=165
AT=269, FSL35=260

The above tests were taken over several days. Although FSL7 was closer to the AT reading once or twice, setting to 35 seems to be closer more often, plus keeping the meter set to 35 prevents me from forgetting to switch the code back to 35 if I use a true AT strip (assuming the AT strips are going to be 35 into the future).

The third test (AT=349...) was high on purpose! Someone had asked if the strips read close to each other at higher numbers, or only in the lower range. I gave Annie a treat a couple of hours prior to this test to see how the strips would read on higher blood glucose. She enjoyed the treat and was back down to AT=221 the next morning."

So, I'm currently leaving the AlphaTrak2 meter coded to 35 for either the FreeStyle Lite strips, or the true AlphaTrak2 strips. My current vial of FreeStyle Lite strips have "code 11" printed on the container, but I ignore this number. My theory is that the FreeStyle Lite and AlphaTrak2 strips are identical and that Abbott just lists different code numbers for use in the different meters. I might be wrong. I do keep a supply of true AlphaTrak2 strips on hand, and will do side-by-side tests with each new box of FreeStyle Lite strips because you never know if Abbott will ever make a change in the strips.

Craig

[peeweek9]

Re: Surgery on a diabetic dog, Possible Somogyi

I'm sure you realize why most of us refrain from suggesting any specific dosage: we are just "parents" like you, but sounds like the one unit increase was needed. I imagine there could be various reasons some vets base dosage changes on a single blood test: parent could become upset with the cost of the full day curve, the dog becoming agitated being locked in a crate / cage for the day and giving false readings, etc.. Most on this forum believe in daily blood testing, and occasional curves done at home, but there are probably tens of thousands of dogs that rely on infrequent testing at the vet clinic and do OK.

About the FreeStyle test strips. I'll copy over my tests I did a week ago from Annie's thread:

"I want to emphasize that the FSL strips are the newer version that mentions the FreeStyle FREEDOM Lite on the box. FSL35 means the AlphaTrak2 was coded to 35. FSL7 means the AlphaTrak2 was coded to 7. (I ignored the code 11 that was marked on the FSL strip container, besides the AT2 meter doesn't have a code 11! Skips from 10 to 12)


AT=95, FSL35=120, FSL7=83
AT=261, FSL35=265, FSL7=234
AT=349, FSL35=352, FSL7=347
AT=221, FSL35=221, FSL7=182
AT=97, FSL35=95, FSL7=88
AT=269, FSL35=292
AT=158, FSL35=155
AT=164, FSL35=165
AT=269, FSL35=260

The above tests were taken over several days. Although FSL7 was closer to the AT reading once or twice, setting to 35 seems to be closer more often, plus keeping the meter set to 35 prevents me from forgetting to switch the code back to 35 if I use a true AT strip (assuming the AT strips are going to be 35 into the future).

The third test (AT=349...) was high on purpose! Someone had asked if the strips read close to each other at higher numbers, or only in the lower range. I gave Annie a treat a couple of hours prior to this test to see how the strips would read on higher blood glucose. She enjoyed the treat and was back down to AT=221 the next morning."

So, I'm currently leaving the AlphaTrak2 meter coded to 35 for either the FreeStyle Lite strips, or the true AlphaTrak2 strips. My current vial of FreeStyle Lite strips have "code 11" printed on the container, but I ignore this number. My theory is that the FreeStyle Lite and AlphaTrak2 strips are identical and that Abbott just lists different code numbers for use in the different meters. I might be wrong. I do keep a supply of true AlphaTrak2 strips on hand, and will do side-by-side tests with each new box of FreeStyle Lite strips because you never know if Abbott will ever make a change in the strips.

Craig

Quote:
Originally Posted by k9diabetes
I know that the last thing you want to hear right now is concerns about the new vet after having to fire the one who missed the diabetes diagnosis. And, again, I hope that maybe there is a gap in communication from the new vet about the plan for Sawyer.

Because I don't think any responsible ophthalmologist or surgeon would do surgery on a dog with dangerously high blood sugar. Right now, blindness is the least of Sawyer's problems.

As others have noted, it is imperative that you start checking for ketones if you haven't already.

If they are present at levels higher than a trace, Sawyer needs immediate treatment to get his blood sugar down and flush the ketones out of his system. Ketoacidosis is one of the few ways that diabetes can kill a dog, and it can go downhill and beyond recovery very quickly.

If he has moderate to severe ketones, he needs to be seen by a vet (probably hospitalized) who thoroughly understands how to treat ketoacidosis. And he probably would be best served by an internal medicine specialist if possible.

As for the insulin and his blood sugar...

It is not necessarily surprising that his blood sugar hasn't dropped because he started on insulin such a short time ago. If he has been at 15 units for the past week, his dose should be increased.

With such high levels, I would, if it was my dog, raise it to 17 units and see if he can hold there for five days before evaluating the effectiveness of the dose, all the while monitoring daily for ketones.

Neuropathy in dogs is not very common but where we do see it often is in dogs with blood sugar in the range of Sawyer's. It typically fades away once the blood sugar comes down.

Right now, having had high blood sugar for such a long time, his body is probably somewhat resistant to the effects of insulin generally. That too dissipates once the blood sugar gets down into the 300s or so.

And he may simply be on not nearly enough of it.

It is wise to start slow and work UP to the right dose of insulin, which can vary dramatically from dog to dog. Our dog weighed 62 pounds and only needed about 9-11 units of NPH, but he was somewhat sensitive and always needed smaller than average doses. On the other end of the spectrum, I have seen a couple of terriers who weighed about 24-25 pounds who needed 21 units of insulin per injection! But were well regulated at that amount.

So it's very important that the vet is not setting an artificially low limit on how much insulin Sawyer needs. He could easily need as much as 1/2 a unit per pound - that would be well within normal limits.

And a dog whose blood sugar is as high as his - and even more so if he has ketones - needs to have more aggressive insulin treatment to get the blood sugar down into the 300s and 400s before moving more slowly to finetune the dose and regulation.

In-hospital, he could be given some faster acting insulin, which would drop his blood sugar faster and also tell you with certainty whether he is responding to the human insulin or may need to try Vetsulin. 99% of the dogs I've seen in 9 years on forums respond to human insulin. I only know of one of literally hundreds who didn't. So chances are he responds to it fine and just needs more than he has been getting and some time to adjust to having insulin again.

I'm worried about him under the current plan... please let us know in as much detail as you can your take on the vet's plan for his blood sugar and the results of his ketone testing.

Natalie
Hey Craig, thanks for the post and I read it to my husband and he said you are likely mixing the insulins at the same time, right?

Also I found this post from the former moderator (not sure), but I found the story quite interesting.

BTW, I wrote to the vet this morning...and I want your opinion, please.

Here is part of my email:

He was 356 at 9:30 pm 7/26

So far today:7/27
533 (4:30 am)
Food, 3 units
324 (10:00 am)

Dr A, I will check the prices of vetsulin and others, but in the meantime can we continue to take Scooter up in small doses on the Novolin N, if I watch his numbers like a hawk? I'm not being obtuse or disrespectful of your opinion because I respect you more than any vet I have ever known. No other vet has taken the time that you have.

I want to try because I'm not sure I can figure out how to spend the time needed in next week, weeks, months monitoring him on a new insulin, etc. (work related) And, I want to see if we can get him back up to a dose close to where he was when he was doing well. I know that he was at 60 morning of surgery and we talked about that and etal, but I am convinced he was starving, had 3 units on board and didn't eat for 36 hours after and it sent him into somogyi. Because I resumed 'normal' with less food and 6 units the very next day, which if in somogyi, was a disaster.

Maybe I think this because I don't want anything underlying condition to be present, but will you work with me to try this first?

I'm just being honest and I would never disrespect your opinion...but this is the option I want to try for many reasons.

E

Craig, what do you think?