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Diabetes and Vetsulin Recap

IMG_0277 I somehow became the non-vet, go-to person regarding dogs and diabetes, I suppose due to my frequent blogging about Violet Rays (left), my greyhound who has been through diabetes, blindness (then cataract replacement), glaucoma and retina detachment.

As you may know, Vetsulin has been discontinued and diabetic animals are being transitioned to Humulin N (or a similar human insulin appropriate for dogs and some cats) or Lantus/glargine (for cats).

"On the Vetsulin 'Recall'" has been very active with over 60 comments, and I get e-mails several times each week with specific questions or comments regarding Vetsulin or transitioning a beloved animal.

Here are some highlights/tips from that post and its comments:

  • The insulin types are:

Humalog/Novolog which are very fast acting (within minutes);
R Insulins, which are fast acting;
N or NPH (intermediate acting);
L (Lente)-a bit longer acting;

U (Ultralente)-very long; and

Lantus (glargine)-the longest.

  • Always have a spare bottle of insulin in the refrigerator. The spare bottle was a bigger deal with Vetsulin, as if you dropped a bottle on a Friday night you might not be able to replace it by Saturday morning, but you would with Humulin (because you can get it at your local drugstore).
  • Do NOT use the syringes for Vetsulin (U-40) to administer Humulin, which need U-100 syringes.
  • The vets I work with agree that testing an animal's glucose level via urine strips is not effective, as you have no idea how long the drops of urine you are testing have been in the bladder. You'll find out what the glucose level in the urine is, but that doesn't tell you what the glucose level in the animal's system is at that moment. The only–only–way to ascertain what's going on with your dog or cat is to take their blood glucose. I use the Accu-Chek Compact. Please note that many of the features of many glucometers aren't that helpful for you and your nonhuman companion. And those features cost money. The one feature that I find very helpful is the preloaded meter with a drum of strips inside it. Otherwise, you have to load one strip at a time, and that involves two hands, one of which you might not have available.
  • Doing a blood glucose curve at the vet isn't necessarily best, as emotions do play a part in the blood glucose puzzle and they are different while at the vet. The internist who helped Violet and I most actually told me to stop going to the vet and to regulate Violet myself at home. That was the best advice I got during that period six years ago.
  • The following factors affect blood glucose: emotions, exercise, food and insulin. When one variable changes, the blood sugar changes. When Violet goes to the baseball field to sprint for 20 minutes she needs an entire extra meal or one less insulin unit. When we have visitors I have to monitor her every couple of hours. Sometimes all is well until the visitors leave, and the following day she comes close to crashing. When someone she's visiting thinks it's a great idea to give her a donut, she needs more insulin. During the summer when it's over 90 degrees and she barely gets two 20-minute walks each day (in addition to walking in and out to pee several other times), she needs more insulin because of her lack of activity. Finally, rolling a bottle of insulin in your palms slowly must be done consistently, particularly with a new bottle. Otherwise, an unusually concentrated or diluted dosage could result, with the accompanying hypo or hyperglycemia.
  • Always have a bottle of Karo syrup or tubes of glucose gel readily available in your home and even your car if your animal travels with you frequently. And make sure everyone in your home and everyone who cares for your animal knows where they are and how to use them. Please note that the effect might not be instant. With Violet, it takes her a couple of minutes to look like she's out danger physically. I've learned that if I administer Karo (or glucose gel) until she stops seizing, in an hour her blood glucose is over 300. Two tablespoons (rubbed on her gums) does the job best, I've learned. It gets her to 60, when she can have a small meal and catch up to her regular curve.
  • Vetsulin had a quality/consistency problem. For me, the problem was that the product was too weak. So her usual 9 or 10 unit dose was 13 or even 14, depending on the bottle. Sometimes it was 9 or 10. My vet's other clients, however, often had the opposite problem, and hypoglycemia resulted. My experience, because I test frequently, was relatively uneventful. And my transition, because I tested frequently, was also uneventful. But I can't imagine attempting a transition without knowing how to test at home. Violet ended up with the same dosage of Humulin that she should have had with a quality bottle of Vetsulin (9 or 10).
  • Take blood glucose before feeding and alter dose if necessary. Don't "chase the perfect curve," attempting to always stay between 90 and 150. That could easily result in hypoglycemia if you don't test frequently.
  • It's true that low blood sugar looks a lot like high blood sugar. But very low blood sugar is life threatening and has a look all its own, complete with tremors and seizures. If your animal ever looks drunk and bumps into walls and falls and flails, don't even bother taking her blood glucose–just start administering glucose.

Please let me know if I missed anything for this post and I'll add it. My goal to be as helpful as possible.

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