Insulin Duration of Action

RE: Insulin Duration of Action

Lucy Fleming — Wed, 04 Jul 2018 12:53:05 GMT

Could the owners learn to curve at home?

RE: Insulin Duration of Action

Anthony Dennison — Wed, 04 Jul 2018 10:43:18 GMT

Owner says she is possibly a little bit more PU/PD, but big thing she is concerned about is that she seems more lethargic and tired in the afternoon (was happening before the heatwave). Last fructosamine suggested there could be periods of hypoglycaemia. So I'm going to drop the dose to 2.5IU BID and then repeat the curve. There is a real possibility there is a degree of stress hyperglycaemia skeing the curve whilst the dog is hospitalised tbh.

RE: Insulin Duration of Action

David Mills — Mon, 02 Jul 2018 23:55:13 GMT

[quote user="Lucy Fleming"]If he's clinically well - maintaining weight, not PUPD or polyphagic etc, and the owners are happy, I'd be tempted to leave be as well. [/quote]

This.

Curves are fraught with difficulty in animals and I believe chronically overused. In humans, more is done on nadir glucose these days, curves are seen as pretty unreliable.

I'd be happy with that fructosamine.

RE: Insulin Duration of Action

Martin Atkinson — Mon, 02 Jul 2018 14:37:15 GMT

[quote user="Lucy Fleming"]My understanding is too rapid a drop in BG can lead to Somogyi effect even it never goes truly hypoglycaemic? (but then I've also heard asserted by others that Somogyi effect doesn't actually happen in animals!) [/quote]Well it certainly does happen in animals or at least something very similar. The problem is that unless you are monitoring constantly then you may have missed the nadir and it was still on its way down or already on its way back up. However if it was happening then I'd expect the fructosamine to be higher. That is when things can go wrong: infrequent monitoring so the curve is misinterpreted and is misleadingly high + high fructosmine = increase dose and disaster!

RE: Insulin Duration of Action

Lucy Fleming — Mon, 02 Jul 2018 10:06:51 GMT

If he's clinically well - maintaining weight, not PUPD or polyphagic etc, and the owners are happy, I'd be tempted to leave be as well.

If he has clinical signs of poor control, may be worth looking more closely at the beginning of the day. My understanding is too rapid a drop in BG can lead to Somogyi effect even it never goes truly hypoglycaemic? (but then I've also heard asserted by others that Somogyi effect doesn't actually happen in animals!)

RE: Insulin Duration of Action

Anthony Dennison — Mon, 02 Jul 2018 09:54:10 GMT

In addition to this, the most recent fructosamine was checked a week before the curve and came back as 394mmol/L - indicates good control but potential for episodes of hypoglycaemia.

With that in mind I'm possibly tempted to wait and see really.

RE: Insulin Duration of Action

Anthony Dennison — Fri, 22 Jun 2018 16:41:01 GMT

Sorry, was just a quick question at the end of the day and didn't get all the details! Dog is clinically well, had a bout of pancreatitis about 6 weeks ago but is stable now.

Fed at 8.30 and given insulin 8.45

9am 20.4mmol/L

11am 7.8mmol/L

12.30pm 13.2mmol/L

3pm 19.4mmol/L

5pm 20.6mmol/L

Was supposed to have hourly BGs but nurses were busy so didn't always get done on time. I'm not sure this is Somogyi because it's not shooting up above what it was pre-insulin dosage.

RE: Insulin Duration of Action

nikki — Wed, 20 Jun 2018 20:34:50 GMT

We have one dog in the practice on prozinc who is doing a bit better than on caninsulin. Changed due to short duration of action of caninsulin.

RE: Insulin Duration of Action

Martin Atkinson — Wed, 20 Jun 2018 10:12:44 GMT

You need to review the whole curve especially how quickly it rebounded after the nadir as this may be a Somogyi effect - are you doing hourly tests? Maybe also worth doing a fructosamine.

RE: Insulin Duration of Action

Rob Loxley — Wed, 20 Jun 2018 08:47:19 GMT

What is the clinical picture; how is the dog? If it's doing well, how much do we need to chase the perfect curve?

RE: Insulin Duration of Action

Charlotte Marshall — Tue, 19 Jun 2018 21:25:16 GMT

I can't see why you couldn't use prozinc. After all we used to use insuvet pzi in dogs before it went off the market. Some of them only needed that once a day.

RE: Insulin Duration of Action

KathW — Tue, 19 Jun 2018 20:30:11 GMT

Do yo have an image of the full glucose curve you can post?

How long has he/she been on insulin for and when was the last dose change?

As well as the nadir the peak level and percentage of the graph thats between certain levels ( I’m away atm and the figured escape me) that are important in considering the bigger picture.

is the patient doing well clinically?