kinds of drugs and its side effects

Traveling With Pet Insulin & Why I Can’t Go to BlogPaws

Will it help Frankie?

As I reported here earlier, Frankie and I had a successful trip to San Diego, where we flew together for the first time.

The insulin I carried with me apparently didn’t fare quite as well.

We had no problems during the trip, but the week following our return… Well, this requires a bit of background.

Diabetes Control and Insulin

For the three plus years since Frankie found the dose and type of insulin that worked well to control his diabetes, he has only had a single hypoglycemic incident. Moreover,  that was early on, when I didn’t realize that, when you get to the end of the bottle, there’s a strong likelihood that the insulin will have pooled in a higher concentration and therefore be stronger.

I know it’s not uncommon for owners of diabetic dogs to deal with hypoglycemic incidents. I also know that the reason that Vetsulin, the pet-related insulin that I have been using successfully, was taken off the market in the U.S. was that the formulation had become unpredictable, so that the blood sugar control became erratic. I did notice some difference in strength in bottles, but I test Frankie’s urine on a twice-daily basis and adjust the dose accordingly. I know glucose urine testing is imprecise; it can only provides an average of blood sugar levels of the period of time between samples. But it’s always worked for me.

Until I got back from San Diego.

The (Literal) Wake-Up Call

About two days after we returned, Frankie fell out of bed in the middle of the night. This in itself would be scary, if I had not put the mattress on the floor after he injured his back leaping off the bed before he was diagnosed with diabetes. (Yes, Frankie and I sleep on a mattress on the floor together. I did mention I’m an old hippie anyway, didn’t I?)  So when he fell out of bed he didn’t fall very far.

But he made a noise. And then he started stumbling around.

Dogs with hypoglycemia look like they’re drunk. It would be funny if it wasn’t a sign of something that can lead to a coma if left untreated.

Treatment is easy: You give food. If your dog isn’t so far gone that he can’t eat, he is generally voraciously hungry. The Karo syrup and other sweets that diabetic dog owners tote around are only for dogs that are too lethargic to ingest anything.

So, Frankie got fed, the vet got called, we returned to our usual routine…

Two days later it happened again, this time right after a long walk. As soon as we got home, the stumbling commenced. The timing was good; Frankie usually gets a little to eat after exercise anyway because his blood sugar is lowered and he gets rewarded for having survived yet another scary car ride to the trail.

But, after three years of near-perfect regulation, I had to figure something was up after the second hypoglycemic incident.

Switching bottles

I had another bottle of insulin left from the stash I got from Canada, thanks to the generous help of Karen of DoggieStylish.com. I’ve blogged about that too. So I thought I would see if trying the other bottle would do the trick.

It seems to have. It’s been more than three weeks now and so far so good. I never had a problem traveling with insulin in a cooler on car trips, but I’m thinking the constant switching from a cold pack in a bag to hotel room refrigerator to cold pack to friend’s house refrigerator to home probably was too much for the fragile medicine.

But while this was happening I didn’t think it was a good idea to make plans to go away to BlogPaws. Hypoglycemia is easy for me to spot but I didn’t feel comfortable leaving Frankie with a petsitter who would either not notice the problem or who, if warned, might panic at the least sign of uncoordinated behavior.

Frankie has been known to get underfoot, slide on carpets, and otherwise be less than graceful.

The next step

I figured it was time to get some more Caninsulin from Canada since I now have only about 1/2 a bottle left. And I thought I would get a large supply just in case… I went into a bit of a panic when I saw that the Canadian pharmacy I had ordered from no longer had it listed. It turned out that the drug only appears on the list of available medications if you check the site from a Canadian server.

Then I thought about it. It seems to be tougher and tougher to get supplies — and the fact that travel had ruined my last bottle got me worried about the medication taking another trip from Canada, especially during a summer when U.S. cities have been experiencing record heat.  Even though I paid $80 to get a two-day UPS rate, it took a week, the stuff got left out in the heat on the porch… In other words, I have no control over what happens to the bottle.

I also got a comment on the story of my Caninsulin saga from Natalie, who runs the excellent K9diabetes forum. She said it was too bad my vet had been less than encouraging about making a switch to a different type of insulin. She said a LOT of dogs successfully transition to NPH, a type of insulin that is made in the U.S., is far less expensive, and is readily available. One bottle gets ruined, you get another one.

If I never had had a problem with Caninsulin, I would have said why mess with a good thing? But I did. And I’ll never know how Frankie will do on NPH if I don’t try.

So I have a call in to my vet to get a new prescription and an appointment for a glucose curve after a couple of weeks of trying. Which means I still can’t travel for a while.

Wish me luck! If he makes the transition successfully, life might just be that much easier for me and Frankie. I’ll keep you posted.

 

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47 Comments

  1. Posted August 4, 2011 at 10:57 am | Permalink

    Good luck with the NPH! You’ll be missed at BlogPaws, of course, but it’s far more important for you to be there for Frankie as he transitions to a new medication!

    • Edie Jarolim
      Posted August 4, 2011 at 11:03 am | Permalink

      Thanks, Maggie — I’ll missing seeing you (all)!

  2. Posted August 4, 2011 at 11:30 am | Permalink

    Edie, I hope that the NPH (which I cannot type without thinking of Neil Patrick Harris… that’s a good omen, right?) works for Frankie! So sorry to hear you won’t be able to make it to BlogPaws, but it’s more important to make sure Frankie is okay. Will keep my fingers crossed!

    • Edie Jarolim
      Posted August 4, 2011 at 1:21 pm | Permalink

      I wish you hadn’t said that, AJ. I really dislike Neil Patrick Harris. He always seems so smug to me. But NPH is just a type of insulin, and I just talked to my vet, who told me that Humulin N was the particular brand I’m going to get. Humulin N sounds a bit like Soylent Green to me, but I won’t go there.

      Now aren’t you glad I’m not going to be at BlogPaws?

      Seriously, thanks for your good wishes.

    • Posted August 7, 2011 at 5:30 am | Permalink

      Ha! I love NPH – Neil Patrick Harris. I hadn’t made the connection, but now I will. 🙂

  3. Posted August 4, 2011 at 12:03 pm | Permalink

    Oh geez, sorry to hear about this, but glad Frankie’s ok! Sure wish Frankie could just come with you to BlogPaws. Cosmo would be happy to keep an eye on him! We’ll miss seeing you there.
    Diane

    • Edie Jarolim
      Posted August 4, 2011 at 1:17 pm | Permalink

      Thanks, Diane. Yes, I realized I was being cryptic by alluding to problems with Frankie’s health so I figured it was time to explain what was happening with his medications.

      Frankie would much prefer *you* to watch him than Cosmo and even that’s iffy; he’s not a big fan of strangers, and strange dogs are high on his list of creatures to avoid. But he always enjoys hanging out with me in hotel rooms, where I set up elaborate step systems to keep him from injuring himself by leaping off the bed.

  4. Posted August 4, 2011 at 12:04 pm | Permalink

    We cannot make BlogPaws this year either. I’m sorry you cannot attend as well. This insulin access has been a real issue for a long time. I’m glad you may be on your way to a more permanent solution.

    • Edie Jarolim
      Posted August 4, 2011 at 1:18 pm | Permalink

      Thanks, Roxanne. Hope you’re doing something interesting — or at least useful — instead of attending BlogPaws.

  5. Shawn Finch, DVM
    Posted August 4, 2011 at 2:59 pm | Permalink

    Oh Edie! Good luck! I sure hope NPH works for Frankie. I hated to see Vetsulin pulled from the market when so many pets did well with. You and Frankie are my heroes (hadn’t told you in a couple of weeks, didn’t want you to forget)

    • Edie Jarolim
      Posted August 4, 2011 at 3:12 pm | Permalink

      Aw, that’s so sweet! Thank you. I hope it works out too and not only for me and Frankie; it might encourage others to feel less stressed if they don’t have Canadian friends.

  6. Posted August 4, 2011 at 5:20 pm | Permalink

    I’m glad you got encouraging news about making the switch for the k9diabetes forum. It sounds like a great resource.

    You can’t learn everything from reading studies and data. Sometimes it’s just nice to have an encouraging friend sharing info with you.

    Sorry to miss you both at BlogPaws. Maybe next year?

    • Edie Jarolim
      Posted August 4, 2011 at 6:07 pm | Permalink

      Yes, I’m feeling guardedly optimistic; if anyone has an informed opinion it’s someone who runs a canine diabetes forum! So maybe it took a bottle of insulin going bad to make me a bit more willing to try something different.

      I was very much looking forward to meeting you, oh accountability committee member. Sorry that’s not going to happen. And yes, maybe next year. Me, not Frankie. He doesn’t do well with social interactions. I’m a little better..

  7. Posted August 4, 2011 at 5:27 pm | Permalink

    I’m so sorry that you won’t be able to attend BlogPaws! I wish there was something one of us could do to make it work for you. Keeping you in our thoughts and sending good positive vibes your way!

    Doreen, Kiko, Millie and Riley
    The Gang at Doggies and Stuff

    • Edie Jarolim
      Posted August 4, 2011 at 6:09 pm | Permalink

      Thanks, Doreen! Aside from the private jet with the cooler that would take us direct from Tucson to the conference center, I’m afraid there’s little that could be done. But I appreciate the good vibes — always!

  8. Posted August 4, 2011 at 11:02 pm | Permalink

    Have you ever considered using human insulin? I have two friends with diabetic pups who swear by it. Since it is regulated by the human health authority, they find a lot less variance between bottles. In hope Frankie feels better soon!

    • Edie Jarolim
      Posted August 5, 2011 at 7:14 am | Permalink

      Yes, the insulin I switched him to is human (it’s even called Humulin!); Vetsulin/Caninsulin is the only kind that was geared towards animals. I’m very happy to hear that you have two friends with diabetic pups who are doing well on it. Frankie’s feeling fine and I hope he continues to on his new regimen. Thanks for your good wishes.

  9. Shawna
    Posted August 5, 2011 at 6:58 am | Permalink

    My goodness Edie! And my husband thinks I have the only 3 dogs in the world with issues! Poor Frankie, you both have to go through a lot to keep his diabetes under control! I had no idea! I sure hope that the new medication works because it sounds like it will be so much easier and cheaper for you. I am sorry that you can’t go to the BlogPaws conference because I REALLY think you’re going to win!!!!

    This is WAY off the subject but you seem to know a lot about every aspect of canine issues….is there anything that can be done for an older dog who seems to be losing her hearing? My sweet pug Chloe, she is 10….

    Shawna M

    • Edie Jarolim
      Posted August 5, 2011 at 7:21 am | Permalink

      If this works out, treatment will become routine again, Shawna — so fingers crossed! As for the Petties, the awards ceremony is going to be broadcast live on YouTube via DogTime so we’ll all find out at the same time, virtually…

      I’m afraid I can’t help with the hearing loss; that’s one for the vet. I love pugs because they’re so funny and good natured. I’m sure Chloe will take her age-related issues with grace if there’s nothing that can be done to reverse them.

      • Shawna
        Posted August 5, 2011 at 7:40 am | Permalink

        Oops, I incorrectly thought BlogPaws was the conference announcing the Petties winners. I’m new to this world of blogs!

        I’ve been thinking about taking Chloe to the vet but I figured there’s nothing they can do for hearing loss and didn’t want to pay $50 to hear that, but I probably should, just in case.

        Hugs to Frankie!

        Shawna M

        • Edie Jarolim
          Posted August 5, 2011 at 7:52 am | Permalink

          No, no, Shawna, you’re absolutely right. The winners will be announced at BlogPaws. I just meant that I can be there virtually if I win — and even if I don’t — which will be some consolation for not being able to be there in person.

          Have you checked any on line veterinary sites to see if there’s any information on deafness in older dogs in general, pugs in particular? The About.com veterinary site has some great information on a lot of things: http://vetmedicine.about.com/

          • Shawna
            Posted August 5, 2011 at 8:01 am | Permalink

            Oh, okay then, I’m not an idiot! Hurray! Haha! I really hope you win! I voted many times for you!

            Thanks for that website! I will check it out!

            Shawna M

  10. Posted August 5, 2011 at 7:27 am | Permalink

    Hi Y’all,

    I really feel for you and Frankie.

    One of the first dogs hubby and I had when we married was a Basenji. In her later years she became diabetic. In those days we did not know that Basenji as a breed suffered frequently from diabetes. Nor was there any source outside of our vet to get info. We took the prescription to the local drugstore and got the insulin and tiny needles along with test strips for her urine. She hated the needles and tried to avoid the constant urine check.

    The only thing that could make having a diabetic dog easier today might be the network available through the Internet. The actual care of the dog hasn’t changed one iota.

    Hawk has his paws crossed and we humans will say a little prayer that the new meds will work well for Frankie.

    BrownDog’s Human

    • Edie Jarolim
      Posted August 5, 2011 at 7:58 am | Permalink

      Thanks, Brown Dog’s Human, who knows first-hand what I’m dealing with! I hadn’t heard that about Basenjis. Frankie is approach-avoid about the shots — literally. He knows he’ll get a treat so he come close then runs away but in the end the desire for the treat wins out. He takes the urine collection in his stride, somewhat bemused by the whole thing. It’s true that nothing much has changed but the support systems help a lot.

  11. Posted August 5, 2011 at 9:06 am | Permalink

    Hey Edie! We use NPH (humulin-N) for Buzz and it’s awesome. It’s super stable and can be refrigerated or not (but do not freeze it! Better to travel with it in a car-temp light-sealed container than with ice!). The protein CAN denature (come apart) in direct sunlight (or when frozen), so just be sure to keep it in the dark – which is why it is recommended to refrigerate it, not necessarily for the temp control, but for the light control. We keep ours in the refrigerator for months and never have a problem with it. We travel with it in a small baggie that I put in my purse (make sure no light can get to it!) – but I’m sure you already know all this. 🙂 Good luck!

    • Edie Jarolim
      Posted August 5, 2011 at 9:21 am | Permalink

      Erin, thanks so much for coming by with this information. In fact I was going to track you down and see if you had any experience, because I seem to recall Buzz was diagnosed after Vetsulin went off the market so it wasn’t an option.

      I didn’t know any of that about Humulin N. My vet didn’t explain it on the phone. The pharmacist said something about it being okay up to a month outside the refrigerator but I didn’t quite know what she meant. I noticed that it looked more uniform in the bottle, i.e., that there was no sediment as there always is with Vetsulin.

      If Frankie reacts well to it, I’m going to feel like an idiot for not trying to make the switch earlier. Thanks again, and I’m so glad that Buzz is doing well.

      • Posted August 5, 2011 at 10:01 am | Permalink

        That’s great! I’m sure he’ll do awesome on it. Just so you know, the insulin seems to last longer than 12 hours in Buzz, so we’ve adjusted his dosing accordingly (gets more at night, less in the morning). I’m not sure what exactly causes that, but since Frankie is a terrier mix and smaller (just like Buzz), you might run into the same problem (we’d give Buzz his insulin at night, then in the morning, his glucose number would still be low, but he never went into a hypoglycemic state). This made it hard to regulate him/took longer than average, but now that we’ve figured it out, he’s doing awesome.

        When we use the insulin, we just roll the bottle around a few times and it’s all mixed up and ready to go. I’m not sure how it was with vetsulin, but the humulin-N doesn’t go bad until it’s expiration date (and all of our bottles have said May, 2013) so we get to use the entire bottle (saves lots of $!).

        The insert will say that the bottle should be refrigerated until use, and does not NEED refrigerated once opened, but our vet suggests refrigerating it (as I said before, just to keep it in the dark).

        • Edie Jarolim
          Posted August 5, 2011 at 10:59 am | Permalink

          Thanks again, Erin. I went to your blog and saw that about the different doses. I’m confused. Why the larger dose at night if the insulin lasts longer than 12 hours and Buzz has lower numbers in the morning?

          • Erin
            Posted August 5, 2011 at 3:58 pm | Permalink

            I was really confused when our vet suggested that as well, because he was so well controlled during the day. As you know, exercise helps the body absorb glucose, so our vet’s thought was to give more insulin at night (when Buzz is mostly lounging around/sleeping), and less in the morning since the night’s insulin would still work for a few hours (plus all the running around/walks help lower his glucose). It was the first time our vet did this type of schedule with a diabetic dog, but it has worked out really well for us. Again, I have no idea why the insulin lasts longer than 12 hrs, but if you’re having a hard time w/it, that could be why. But I guess you’ll just have to wait and see!

          • Edie Jarolim
            Posted August 5, 2011 at 4:24 pm | Permalink

            That makes sense when you explain it that way. It’ll be an adventure. My vet had me start at only 1 – 1 1/2 unit — he said said it was one unit per 4 kilos — which I’m sure is too low, but I’ll go up slowly. Frankie seemed a bit low energy today with that dose so I took advantage of that to gave him a bath. That had him zipping around the house afterwards, shaking himself off vigorously!

  12. Posted August 5, 2011 at 12:59 pm | Permalink

    It’s funny, Edie, you were the first blogger I contacted when I finally started to figure out how this blogging business works, and in my head you for sure had to be at BlogPaws. I mean, you’re blogger-in-chief, right? (In my head, anyway!) 🙂

    I so badly wanted to go too, but this, like so many other things, will have to wait for a different stage in my life. I’m sure Frankie’s going to do fine: just a gut feeling, but that fluffy little face is too cute to have issues he can’t conquer!

    • Edie Jarolim
      Posted August 5, 2011 at 1:08 pm | Permalink

      Ha, I wish my blog traffic reflected your perception, Lori, but it makes me happy that someone sees me as Blogger in Chief (besides Frankie, who doesn’t know many other bloggers). Thanks for your good feelings for Frankie; he *is* a tough little guy for all his “issues.”

  13. Clare
    Posted August 5, 2011 at 9:47 pm | Permalink

    Edie, I just wish that some of the less vigilant dog guardians could review your stellar record with Frankie and imitate it: how many dogs survive, no THRIVE, after 3 years of diabetes? Mostly those cared for by you.

    • Edie Jarolim
      Posted August 6, 2011 at 7:27 am | Permalink

      I thank you, Clare, but I think there are many dog guardians who deal with chronic diseases just as vigilantly as I do. In fact, now I’m feeling a bit ill-informed about the switch over from Vetsulin/Caninsulin.

  14. Posted August 5, 2011 at 10:33 pm | Permalink

    Hi Edie,

    I happened to stop in just in time to hear about the switch to NPH! Wishing you and Frankie luck as it’s getting harder and harder to get hold of some Caninsulin.

    When most of the dogs made the switch last year, we recommended reducing the Vetsulin dose by about 20-25%. You don’t really need to start over. The two insulins tend to have a very similar action and every dog who made the switch wound up at a similar dose of NPH as they were on with Vetsulin.

    Unfortunately, the AAHA recommendations called for starting over. They sort of combined cats and dogs. A switch from Vetsulin in a cat to the insulins recommended for them is a huge switch as they are going from an intermediate acting insulin to a long acting… I would never have put any cat on Vetsulin. So for cats, they really needed to “start over.” But dogs don’t. And in the following web seminar, Dr. Nelson from UC Davis says as much when he gets to talking about the switch in dogs toward the end of the presentation. He says he would drop the dose “a few units” when making the switch.

    Webinar on Vetsulin switch

    Not sure if Frankie started at a very low dose. If so, maybe have the vet take a listen to this presentation. Much better than the AAHA guidelines.

    I also wanted to mention that I’m a proponent of giving some syrup to any dog who has signs of hypoglycemia and then following with food. Especially if you don’t know how low the blood sugar is or if you do and it’s below 50. Food takes time to be digested and converted to glucose and the blood sugar could be continuing to drop while that digestion process is pending, perhaps going to dangerously low levels.

    So I always gave some syrup to put a stop to any further drop in the blood sugar while giving the food a chance to do its thing.

    Natalie

    • Edie Jarolim
      Posted August 6, 2011 at 7:24 am | Permalink

      Natalie, thanks so much for this information, both about the switchover and the hypoglycemia. I think this calls for guest post… the information is too important to relegate to the comments section.

  15. Posted August 6, 2011 at 9:38 am | Permalink

    Good luck with the switch and if you want to go back to Caninsulin, I will be more than happy to get it for you.

    • Edie Jarolim
      Posted August 6, 2011 at 10:12 am | Permalink

      Thanks, Karen. I can’t tell you what a comfort it is, knowing you have my back (and Frankie’s) in case this doesn’t work out. If only UPS and U.S. Customs weren’t involved.

  16. Lisa
    Posted August 6, 2011 at 10:30 pm | Permalink

    Frankie is in my prayers.

  17. Posted August 7, 2011 at 5:29 am | Permalink

    Oh Edie. I can relate to those visits to the vets to monitor glucose levels for my cat. I am sorry that you won’t be attending BlogPaws. I can’t either, but you’re like a staple there! Well, at least you are someone I would expect to be there.
    I can completely understand though. Frankie needs mom to be there right now. Much safer for him. I hope all goes well on the NPH and that you will be reporting it here.
    I know BlogPaws will miss you!

    • Edie Jarolim
      Posted August 7, 2011 at 10:59 am | Permalink

      Ah, I didn’t know you had a diabetic cat. So you know exactly what this is all about… I will definitely report back on Frankie’s progress.

      I will miss BlogPaws too — but at least I won’t miss meeting you there; I would have looked forward to that!

      • Posted August 7, 2011 at 1:22 pm | Permalink

        Now I am blushing. Thanks.
        I would have loved to meet you in person for sure!
        Hope all goes well with Frankie. Diabetes sucks.

  18. Posted August 7, 2011 at 10:09 pm | Permalink

    Wow, what an ordeal! Good luck, of course!

    Just wondering, since the insulin seems so sensitive, would it help it it was in some kind of thermos on top of being in the cooler, fridge etc …? Wouldn’t that temper the changes? Just a thought.

    • Edie Jarolim
      Posted August 8, 2011 at 8:26 am | Permalink

      Thanks, Jana. The new insulin I’m trying is less unstable — it doesn’t even need to be refrigerated — so that should help. The problem with flying with insulin is that there’s a limit to what you can take on the plane — your dog is considered your single carry on!– so the cold pack was doable but anything larger like a thermos would have been impossible.

  19. Posted August 27, 2011 at 3:05 pm | Permalink

    Wow. What a great dog mom Frankie has. Hope he gets to feeling better soon. Sad we missed you at Blog Paws.

  20. Posted January 7, 2013 at 6:00 pm | Permalink

    I am in the military and headed to the Middle East from Japan. One of my pets, “boogie”, has diabetes. Can she fly safely since they can only allow her to fly as cargo to the country I am going to? Her glucose curve was good and she is doing well so far. It will be a 24 hr process from the time she boards until she arrives. A friend told me that insulin is mainly used for when she eats to control food so since they cannot eat then insulin isn’t required during the flight? Does not sound totally correct. Need advice..thank you.

    • Edie Jarolim
      Posted January 7, 2013 at 6:09 pm | Permalink

      I don’t think it’s safe for a diabetic to go for so long without food and insulin. That’s going to throw her blood sugar off and it could be tough to get her regulated again. Most dogs need insulin every 12 hours. Is there a way to break up the flight — i.e., with a layover in another country — so you can take her along safely?

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