Insulin switching

Re: Insulin switching

Martin Atkinson — Sat, 01 Jan 2011 17:56:33 GMT

Alison Howell said:

'We were always told at uni to look at the dog not just the test and this isn't a case that will be possible to do a lot with'.

I think there is a lot to be said for this as once you start monitoring closely you realise how unstable your diabetics really are and you will never stop chasing numbers. If they are clinically stable then it may be prudent to leave well alone but I believe you need a bit more monitoring than this dog has had in the past. If they are unable/unwilling to allow you to monitor this dog more frequently I would tell the client that you cannot control thier dog's diabetes satisactorily and basically it is out of your control. Some clients are very willing to do a curve at home if you lend them a glucometer and show them how to take a sample, they surprise me sometimes how well some you'd think couldn't do it cope but others who seem confident/competant can't. It helps if there is a diabetic human in the family.

Michael Woodhouse said:

'I was taught at college that insulin resistance was 2 units/kg, you are no where near that amount'.

I have long since realised that most of what I learned about DM (indeed anything!) at college is bulls**t and there is no normal case or normal dose. You have to take all possibilities into consideration. How can anyone give a figure that proves resistance?, some are going to be more or less resistant than others - resistance doesn't happen overnight. Certainly it may not be a major concern if you're not changing insulin until you're giving >2iu/kg but if you are changing, then a minor resistance (or just a variation in sensitivity) could easily be brought to light as is possible in Alison's case.

Re: Insulin switching

Christopher Saul — Fri, 31 Dec 2010 20:47:45 GMT

[quote user="alison howell"]

Have people been been switching straight across on the same dose, reducing it slightly, or what?

[/quote]

I think the recommendations are something along these lines.... For dogs who have a marked difference between pre injection and nadir glucose, a reduction in dose of 10-30% is appropriate when switching from lente to caninsulin.

For those dogs who have minimal variation of their glucose curves then you can covert dose-for-dose.

Myself, If I'm a bit unsure, I tend to reduce the dose by about a quarter

Re: Insulin switching

Michael Woodhouse — Fri, 31 Dec 2010 18:41:38 GMT

[quote user="alison howell"]Insulin resistance sounds very likely and would explain the severe hypo...I suggested going down to15iu bid initially..[/quote]

I was taught at college that insulin resistance was 2 units/kg, you are no where near that amount. The preds should increase insulin resistance further and potentially increase the required dose. TBH I usually start dogs off at 1unit/kg Caninsulin, I tried starting lower but was taking a long time to get a sufficient dose for quite a few dogs. We only have a few diabetics but they are all on more than 1 unit/kg and less than 2 units/kg [at the moment just once daily dose].

Re: Insulin switching

vs0u — Fri, 31 Dec 2010 18:12:14 GMT

Thanks for the replies.

The dog is a normal body condition and has been steady for the last 6 months at 30kg. The preds are 5mg once a day for a skin condition. It is very much palliative with this dog, as it is blind and old, so there is no chance the steroids can be stopped as he just gets too itchy.

Money is an issue so glucose curves/fructosamine have not been done as often as ideal - and there has been some tinkering with dose rates without doing more tests.

It is a very happy dog, drinking is steady and weight stable. We were always told at uni to look at the dog not just the test and this isn't a case that will be possible to do a lot with.

Insulin resistance sounds very likely and would explain the severe hypo...I suggested going down to15iu bid initially..

Re: Insulin switching

Martin Atkinson — Fri, 31 Dec 2010 11:31:00 GMT

Alison, when you say the dog had been stable for some months was that based on regular fructosamine tests and glucose curves or just the clinical picture? If the dog is on steroids then obviously the dose of insulin may be affected by that but presumably nothing had changed in the one week after switching so that suggests the dog had developed some resistance to the original insulin, especially as Insuvet is porcine and Caninsulin bovine, and is now being relatively overdosed. I would stop all insulin until the BG stays above normal then would resume by reducing the dose by 25% and do a glucose curve in 5 days, adjusting the dose accordingly and repeating the curves until it's stable again. I would do a fructosamine at least once a month plus maybe an alternate time of day BG i.e. just before/after dose and at predicted nadir, and a full curve every three months even on apparently stable diabetics. Also is it not possible to review why this dog is on steroids and stop them? But what I have learned is that there is no 'usual' dose or 'normal' case - they all have to be treated as different. The more I check my diabetics the more I realise how unstable they are and just worry more about them!!

Re: Insulin switching

Andrew Mellor — Fri, 31 Dec 2010 10:58:10 GMT

according to the vet at schering plough some time ago anything up to about 2 iu / kg would be classed as normal as long as a good curve being created if not then resistance likely

Re: Insulin switching

Noweia — Fri, 31 Dec 2010 09:32:37 GMT

I've switched a couple from PZI to Caninsulin, no problems as of yet. There was a sheet posted out to all vets with info about switching and doses, which has been very helpful so far.

There's a sheet here: http://www.viovet.co.uk/support/index.php?_m=knowledgebase&_a=viewarticle&kbarticleid=23

Covers Lente and PZI.

Re: Insulin switching

Mark Hedberg — Fri, 31 Dec 2010 07:57:32 GMT

1. What dose of steroids?

2. what's the dog's body condition? Normal or obese?