Wiggins Story

[Bnnclvr]

Wiggins is a 9 year old wire-hair fox terrier. We got him when he was a couple of months old, and before he reached 9 months he developed severe skin allergies (he would scratch himself until he bled). We had blood tests run to see what he was allergic to, which was almost everything. They developed an antigen and we gave him shots once a day and eventually once a week. During this period he was on Temaril-P to keep the scratching under control, but he still scratched and his skin quivered every time you touched him, which is does to this day. He does loved to be brushed/scratched. After a couple of years we found the allergy shots did not work and we eventually took him off. About 6 months later, even taking the the Temaril-P he was scratching himself and bleeding. We went to a veterinarian allergy specialist who tried some additional allergy medication and once again did all the blood tests, and put him on a new set of allergy shots. After a year and a half, Wiggins was no better. When he was about 6 years old he was diagnosed with a thyroid condition and put on Soloxine. When he was 8 he was diagnosed with diabetes and we were told he would have to get off the Temaril-P, which was not a pleasant thought. We tried many allergy drugs, including sprays, and found a combination of a spray and Hydroxyzine/atarax that finally got him to stop scratching himself until he bled (although he still scratches himself).

His initial blood sugar was approximately 390, and he was given a dose of 8 units of vetsulin (6 am and 6 pm). We did a wave approximately 1 month later (6 hours after an injection) and his blood sugar was at 280. We moved his dose to 10 units of vetsulin and did another wave 1 month later and it was at around 180 (6 hours after an injection). After the third or fourth wave we finally ended up giving him 15 units and his blood sugar was at 120, which we thought was safe. He was on 15 units for about 1 month and suddently went into shock. I called his regular vet to find out what to do and they could give me no information. We went online and found that you can give them karo syrup via syringe, which we did. We then lowered his dose to 13 units. We had no faith in the vet and assumed since he was at 15 units for so long and was okay, 13 would do the trick. It was around this time that he lost his sight. Approximately 1 month later he again went into shock taking 13 units twice a day. After that his dose was lowered to 11.5 and in 3 weeks he again went into shock. We now have him at 9 units (for the last couple of weeks). We purchased a glucose monitor 1 week ago and we checked his blood sugar that night after we gave him his 6 pm injection. It registered 26. We gave him some karo syrup and hoped for the best. The next morning we took his blood sugar and it was 385. We reduced his insulin to 6 units and that night his blood sugar was 285. The next morning after his injection his blood sugar was 36. We gave him 9 units that night and we checked his blood sugar and it registered 249. The next morning his blood sugar was 82, and the next night 242 (still using 9 units). His blood sugar seems to be all over the place and drawing blood is very difficult (we do it at the base of his tail). We are going to start checking him every Saturday and Sunday (6 hours after his injection) to see where he is at (we both work). At this point we are keeping his dose at 9 units and are mostly depending on how he seems to feel (if his tail wags it is a good day and if he can do his usual 30 min. walk every morning without my carrying him the last few blocks it is a good day). We have him on a diet of homemade whole grain rice/oatmeal, ground turkey and fresh vegies (cooked in a crockpot), along with 1/4 regular dog food. He gets approx. 3/4 cup to 1 cup in the morning and again at night. I would like to be able to level out his blood sugar level, but am feeling pretty helpless right now. Wire hair fox terriers are known for being "fearless." But at this point Wiggins is anything but fearless.

[eyelostit]

Hi and Welcome :)

Is Wiggins getting one shot or two shots a day? If just one shot a day please post back on advise for this.

Aw poor Wiggins, may I ask how much of the rice, oatmeal and veggies, turkey you put in the crockpot?

How much of this mixture goes along with the 1/4 C of dogfood and what type of dogfood does Wiggins eat.

Could be some rebound going on, with getting the lows then the highs, the food and insulin may not be matching to the insulin dose.

Was wondering if you ever tried cider vinegar for his skin allergies.


Dolly

[We Hope]

Welcome to you both!

In order to see where things are happening with Wiggins, you need to either do a curve yourself with your meter or have one done at your vet's. Taking blood and testing it every 2 hours for about 12 hours should give you a good picture of Wiggins' highs and lows and when they are occurring.

http://www.vetsulin.com/vet/Monitoring_About.aspx

http://petdiabetes.wikia.com/wiki/Curve

It could be that Wiggins needs slightly less insulin in the evening than for the daytime; the morning and evening doses don't need to be equal. It just works out that way for some dogs; others need more insulin in the day than at night and vice-versa.

Learning about Wiggins' highs and lows will allow you to see how the insulin is working for him at various points in the day. This means you can give a small snack, for example, if you see he tends to go low at a certain point. It also means you can work with his food to make it work better with his insulin.

Many dogs do well when more fiber is added to their diet. This is what the prescription-type diabetes diets contain and it can be a help to even out glucose absorption (which can translate into better and more stable numbers). Adding fiber can also mean that less insulin is needed for good and stable bg control. You don't need to necessarily go with the prescription "diabetes foods", as you can increase the amount of fiber in the food yourself with things like solid pack (no sugar or spices added) pumpkin, etc.

Am hoping you've found another vet for Wiggins because I can't think of a doctor of any type who wouldn't know what to do for hypoglycemia, especially when it's known the patient has diabetes and is using insulin!

Kathy

[AlisonandMia]

When did Wiggins come off the Temeril-P? Was he still on it, being weaned off it, in the early days of being diabetic?

Alison

[Bnnclvr]

Dolly - I have never tried cider vinegar - do you mix it with water and spray it on? He gets an insulin shot at 6 am and 6 pm. The food I make is basically one-half bag of whole grain brown rice, 3 lbs. lean ground turkey, and one-half container of oatmeal, along with usually 6 or 8 stalks of celery cut up and froz. peas. I mix it 3/4 c. to 1/4 c. regular dog food. I have been trying different dry dog food and have it in a large tupperware container and don't know what kind I have now.

[Bnnclvr]

When did Wiggins come off the Temeril-P? Was he still on it, being weaned off it, in the early days of being diabetic?

Alison
I was told by my vet to take him off Temaril-P immediately because it interfered with the insulin (made it not as effective). We weren't able to back off of it slowly.

[Bnnclvr]

Welcome to you both!

In order to see where things are happening with Wiggins, you need to either do a curve yourself with your meter or have one done at your vet's. Taking blood and testing it every 2 hours for about 12 hours should give you a good picture of Wiggins' highs and lows and when they are occurring.

http://www.vetsulin.com/vet/Monitoring_About.aspx

http://petdiabetes.wikia.com/wiki/Curve

It could be that Wiggins needs slightly less insulin in the evening than for the daytime; the morning and evening doses don't need to be equal. It just works out that way for some dogs; others need more insulin in the day than at night and vice-versa.

Learning about Wiggins' highs and lows will allow you to see how the insulin is working for him at various points in the day. This means you can give a small snack, for example, if you see he tends to go low at a certain point. It also means you can work with his food to make it work better with his insulin.

Many dogs do well when more fiber is added to their diet. This is what the prescription-type diabetes diets contain and it can be a help to even out glucose absorption (which can translate into better and more stable numbers). Adding fiber can also mean that less insulin is needed for good and stable bg control. You don't need to necessarily go with the prescription "diabetes foods", as you can increase the amount of fiber in the food yourself with things like solid pack (no sugar or spices added) pumpkin, etc.

Am hoping you've found another vet for Wiggins because I can't think of a doctor of any type who wouldn't know what to do for hypoglycemia, especially when it's known the patient has diabetes and is using insulin!

Kathy
I would like to try the monitoring every two hours. We really have a hard time getting blood from him (we are doing it at the base of his tail and it takes quite some time). We put the needle in all the way and twist it and it takes a lot of massaging to get blood.

[Bnnclvr]

I would like to try the monitoring every two hours. We really have a hard time getting blood from him (we are doing it at the base of his tail and it takes quite some time). We put the needle in all the way and twist it and it takes a lot of massaging to get blood.
I didn't know there was prescription dog food for diabetic dogs?

[forloveofandy]

How much does Wiggins weigh?

I am so glad you found this board. There is a wealth of information here.

Hang in there. It is going to get better.

[k9diabetes]

Hi and welcome to you and Wiggins!

I'm sorry you have had such a rough time of it. I don't know if you have ever read my dog Chris' case study but he had a somewhat similar experience in that once he started insulin his dose kept dropping. In his case, his pancreas got a break from injected insulin and he "honeymooned" - his insulin production started up again. This can happen, especially if you catch the diabetes fairly early. Eventually, though, the pancrease fails altogther. Chris honeymooned for about six months, which is a long time. His case study is at www.k9diabetes.com/k9diabetes.pdf (http://www.k9diabetes.com/k9diabetes.pdf).

I had a couple of thoughts while reading through your story, which I summarized below.

One is that his pancreas might have recovered some, as Chris' did, allowing him to need less injected insulin. Especially after many years on Temaril-P, which contains some steroid.

Another is that while his blood sugar was high he built up some resistance to the effects of insulin. That is fairly common. Eventually, as the body spends more time at more normal blood sugar, the resistance dissipates and then you need less insulin to get the same effect.

Another is that the thyroid medication may need adjusting. Thyroid affects metabolism and insulin processing.

Most likely your meter reads the blood sugar somewhat lower than it actually is but still I would like to have his lower readings like the 82 come up a bit for safety given what's happened already.

After a hypoglycemic episode, the blood sugar can be out of whack for several days afterward so you might see higher numbers in the 48 hours after a hypoglycemia and think he needs more insulin when really it's just a short term spike from jolt of hormones caused by the low blood sugar.

The other complication is that the level of his allergies will also affect his blood sugar so you may always see some variability.

I recommend that you settle on a dose of insulin where his blood sugar never goes too low... 6, 7 units, 8 at most. And stay on that dose for a full seven days after any low blood sugar episodes.

Let's say you drop the dose to 7 units. If no hypo occurs, stay at 7 units for a full 7 days and then evaluate the blood sugar at that point. If he still goes low on 7 units, drop to 5 and stay at that dose for a full 7 days.

You need to give his body time to stay on one dose for an extended period without the influence of the panic hormones that come into play when the blood sugar goes too low. Then, once you have done that, you can do a curve or mini-curve - as much testing as you can manage - and see how the blood sugar is after a week on a stable schedule of food and insulin.

The other thing is the exercise - that can have a HUGE effect on blood sugar. It has to be timed very carefully and it could send his blood sugar very low if it's on the low side already. I love exercise for any dog but right now, if you think it won't torture him, I'd skip the walks so you can limit the variables involved and find out more about what his blood sugar is doing.

You may find, after doing this, that he needs a different amount of insulin at night, as Kathy mentioned. The best way to find out is to eliminate as many variables as you can, stay at a safe dose even if it means his blood sugar is sometimes higher than you would like, and then assess his progress on that dose. We can help you sort out the results of this and make decisions about what to do next.

Sorry it's so long an answer... hope it makes some sense!

Please tell us how much Wiggins weighs also.

Natalie
_________

Wiggins
9 year old wire-hair fox terrier
6 years old diagnosed thyroid condition, put on Soloxine
8 years old diagnosed with diabetes, taken off Temaril-P

first dose 8 units of vetsulin (6 am and 6 pm), upped to 10, then to 15
stayed at 15 units about a month, then hypo
lowered to 13 for one month, another hypo
lost his sight
lowered to 11.5 units for three weeks, another hypo
lowered to 9 units a few weeks ago
Started home testing about a week ago at base of tail
Meter read 26 after 9 units.
lowered to 6 units
On 9 units, 249 evening, 82 morning, 242 next evening

usual 30 min. walk every morning

Diet homemade whole grain rice/oatmeal, ground turkey and fresh vegies (cooked in a crockpot), along with 1/4 regular dog food. He gets approx. 3/4 cup to 1 cup in the morning and again at night.

[eyelostit]

Dolly - I have never tried cider vinegar - do you mix it with water and spray it on? He gets an insulin shot at 6 am and 6 pm. The food I make is basically one-half bag of whole grain brown rice, 3 lbs. lean ground turkey, and one-half container of oatmeal, along with usually 6 or 8 stalks of celery cut up and froz. peas. I mix it 3/4 c. to 1/4 c. regular dog food. I have been trying different dry dog food and have it in a large tupperware container and don't know what kind I have now.

Ok, Natalie (K9diabetes) suggested lowering the dose and staying with that for a week while checking the bg to prevent the lows you have been seeing.

When are you seeing the high readings AM fast or PM fast?

Are you giving any treat? and does Wiggins get some exercise before you see the low readings.

If you lower the dose and we don't see the lows anymore we can then suggest some food tweaks if you are getting high numbers again, its hard to tell without seeing those lows going away and you have had a hypo event.

If you can please post a full days curve, and let us know what meter you are using.

Below are 2 links about the cider vinegar, the other is the search I did on it and there are various links listed.

http://www.paw-rescue.org/PAW/PETTIPS/DogTip_InsectBites.php (http://www.paw-rescue.org/PAW/PETTIPS/DogTip_InsectBites.php)

http://www.google.com/search?q=cigar+vinegar+for+pet+skin+allergies&rls=com.microsoft:en-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1 (http://www.google.com/search?q=cigar+vinegar+for+pet+skin+allergies&rls=com.microsoft:en-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1)

I hope this helps and hang in there ;)

Take care :)
Dolly

[Bnnclvr]

Natalie - All that you said makes a lot of sense. Today is Saturday, so we are going to check his blood sugar every two hours. I have had him on 9 units for the past week, including this morning (I just read your post). His tail is wagging again, but I am going to reduce it to 8 to be on the safe side. I didn't realize that the pancreas can actually recover to some degree and how that related to the Temaril-P. He is also starting to drink a little more water, which he wasn't doing with the high dose of insulin. I can now see hope for Wigs getting his diabetes under control. I really appreciate your time and your clear message. Thank you.

[Bnnclvr]

Natalie - I live in Denver. I have tried looking on the internet for dog diabetes specialists but have not come up with anything. Are you aware of any good vets in this area?

[k9diabetes]

I am very anxious to see the results of the curve!

There aren't really diabetes specialists... there are Internal Medicine Specialist veterinarians who specialize basically in all things more complicated, including diabetes, and it is often helpful to see an IMS. They are likely to have treated more diabetics than a general practice veterinarian.

Even among IMSs, there are still those who are good and bad with diabetes.

The vet schools for years have not only not taught vets to put home blood glucose testing to work but have actively discouraged it and the better regulation that comes with it. We took Chris to an endocrinologist at a veterinary teaching hospital and he was dismissive of home testing and saw dogs as "regulated" when they become an acceptable pet again because they no longer have accidents in the house - Chris never had one to begin with. For a while that vet school was hammering away at using only fructosamine testing and clinical signs. So those approaches radiate out from the vet schools through all of their students.

Fortunately, many vets have come to appreciate home testing and it's a matter of finding a vet who is flexible, open to new information and ideas, and interested in getting the best regulation possible. They also need to take your expectations and desires into account - if they dictate to you instead of treating you like an essential part of your dog's treatment team, that's a problem. You know your dog better than anyone on the planet so your input is essential. And you're the one who has to day by day make decisions.

Some states seem to fall into the "difficult" category when it comes to vets! I know that sounds strange and it's strictly anecdotal but after five years participating on diabetes forums, it seems there are geographic areas where good vet care is really hard to find for a diabetic dog and Colorado has been one of those. I hope you will put a dent in that impression by finding a really great vet for Wiggins. :)

I don't think we have a Coloradan on the forum right now. But you can look up IMS through the the ACVIM:

http://www.acvim.org/websites/acvim/index.php?p=3

This database may not be up to date and if you find a clinic that interests you, the large specialty ones typically offer IMS and their websites will usually tell you a bit about the doctors.

Natalie

[peggy0]

My favorite Vet moved from Dallas to Colorado Springs. He is not a specialist but one of the most caring vets I ever worked with. One of my springers had a very rare platelet disorder and was urinating blood, pure red urine. It was terrifying. He worked for days with Internal Medicine Group determining what it was, diagnosed it and he is now 13 years old and fine. I don't know how far Colorado Springs is from Denver, but he is a young great vet. I can email him if you'd like and see if he can refer an Internal Medicine Doctor in Denver.

[pgcor]

Hi!

I don't think I caught your name in this thread, but I wanted to say welcome. I also wanted to say that I've been to 5 or 6 different Vets (I've lost count now!) since my Pip was diagnosed. I never found anyone in my area (Chicago) that was savvy with this diagnosis.

However, my original Vet was at least open to listening to the information I learned on this board and what I was able to read in books. That my be the best you can do. I wouldn't discourage you from looking, a good Vet is a God send.

The first internal specialist I saw told me to stay off the board and listen to him! He didn't think I needed to ever check Pip's blood or urine! Common sense told me that was odd.

The information I received here was spot on - so you're not alone! I used to live in Denver and from what I remember the Vets were better than I've found here!

Good luck to you and Wiggins!!

[CarolW]

I just finished reading through your thread - and also don't remember seeing your name, though I won't forget Wiggins's name!

What a time you've been having. I feel VERY sure you'll very shortly be doing lots better, with all the help available here. Actually, you did extremely well just to keep Wiggins alive through those hypos!

You don't HAVE to use the base of the tail for testing; there are other locations you can prick instead; you might investigate the possibilities. I have a detailed description of the Lip-Stick on my web site, which is very like the video Natalie has of Chris and testing his "lip." It's not really the lip you prick, but the inner lining of the mouth.

The description on my site goes into considerable detail about the finer elements of testing, such as warming the site before pricking, along with some tips about handling the meter. What meter are you using? I have the OneTouch Ultra2, which I love. First, Natalie posted a review that shows it rated quite high for consistency (say, compared to the animal-validated AlphaTrak meter), and that is here:

http://k9diabetes.com/forum/showpost.php?p=9647&postcount=18

It's actually an abstract, but gives the idea.

I see Natalie has mentioned the usefulness of fiber in the diet. I'm feeding a vet prescription diet to Kumbi, and it's suiting him extremely well. I'm in Canada, and using Medi-Cal Fibre Formula. However, Medi-Cal recently merged with Royal Canin, in the U.S., which also has vet prescription diets for diebetic dogs.

I'm most interested to discover that the canned version (I use both dry and canned) - now has a Royal Canin label along with the Medi-Cal label. I ALSO just noticed that the content of one can is down from 396 to 385 grams; undoubtedly, for the same price as before, though I didn't check that; I will. I buy by the case. And I buy a large bag of the dry food, because I feed it to my other dog, elderly Kwali, as well.

Please stick around, and keep asking questions. Oh, one other thing - you might look for the book by Dr. Nancy Kay called _Speaking for Spot_, as it could maybe help you interview veterinarians. Although I don't necessarily agree with absolutely EVERYTHING Dr. Kay says, I do agree with most of it. I put her on my links page; that's how good I think she is.

If there IS a pretty good vet in the Denver area, good interviewing techniques could help you find that vet. I am just very lucky that my OWN vet specialized in Internal Medicine, and took highest honors, and she is a really great vet.

Needless to say, I'm a terrier nut - well, I'm really an ALL-DOGS nut! But I have a special place in my heart for a dog like Wiggins - and for you, too. Please keep reports coming in; we'll follow them!

Sun, 6 Sep 2009 19:38:49 (PDT)

[eyelostit]

Just checking in on you and Wiggins.:)

Dolly

[Margaret Boyle]

Hi,
I never saw your name but welcome to you and Wiggin.:D

You have certainly came to the right place lots of lovely people and plenty of support.:cool:

Hugs to you both.

[Bnnclvr]

Dolly - Thanks for checking on Wiggins. We did a lot of testing over the last couple of days (or at least it seemed like a lot since blood his blood is so hard to draw). The results are below. FYI Wiggins weighs 30 pounds (down from 41 when he was originally diagnosed). I use a One Touch Ultra Mini and I understand it reads about 50 points low.

Friday night - 9 units

Testing:
Sat a.m. - not consistent testing - we were in an out all day (gave him 9 units 6:30 am)
8:30 am - 244
11:30 am 148
2:45 pm - 123
6:45 pm - 137 (and gave him 8 units)

Sun
6:30 am gave him 8 units
6:30 am - 338
8:30 am - 146
10:30 am - 97
11:30 am - 59 (gave him 1/4 c. dry dog food - worried about low number)
2:30 pm - 321
4:30 pm - 448
5:00 pm gave him 9 units
7:45 pm - 344

Monday
5:45 am gave him 8 units
5:45 am - 181

I have received lots of helpful replies and I need to go online and check out an easier way to draw blood. Wiggins range seems to vary a lot - what do you think?

Thank you for taking the time to help :)

Bonnie

[Bnnclvr]

Natalie - I am not sure when I post a reply that everyone can see it. In reply to your suggestion to do a curve, below is what I have done over the past couple of days:

Friday night - (9 units)
Testing:
Sat a.m. - not consistent testing today - we were in an out all day (gave him 9 units 6:30 am)
8:30 am - 244
11:30 am 148
2:45 pm - 123
6:45 pm - 137 (and gave him 8 units)

Sun
(6:30 am gave him 8 units)
6:30 am - 338
8:30 am - 146
10:30 am - 97
12:30 am - 59 (gave him 1/4 c. dry dog food - worried about low number)
2:30 pm - 321
4:30 pm - 448
(5:00 pm gave him 9 units a little early because # was so high)
7:45 pm - 344

Monday
(5:45 am gave him 8 units)
5:45 am - 181

(I am rather concerned about the 181 reading and am not taking him for a walk this morning. Any suggestions?) I should be home most of the day so I can take readings every 2 hours again).

Bonnie

[peggy0]

I sure don't like the 59, the 400 is probably in response to that low, but 181 isn't low and i wouldn't be concerned abou it at all. the 59 may be a result of the 9 units. I'd keep him steady for at least a week and keep monitoring him. Good luck with Wiggins. Great name.

[Bnnclvr]

Peggy - I am desperate to find a good vet who knows what he is doing. I would appreciate your checking with your vet in Colorado Springs. We have spent thousands of dollars on Wiggins' allergy problems with allergy specialists (blood testing several times at $600+ each, and the antigens and vet visits for several years) only to be no better off and to have him on a steroid for almost 8 years. They of course gave us no guarantees that anything they did would work. I am glad I found this board and at least can learn from everyone's experiences. Thank you. Bonnie

[k9diabetes]

Hi Bonnie,

Sorry... I left this page up on my computer all night - wasn't actually here after about 9pm. I hate it when I do that!

It's hard to say if the higher numbers were rebound or just the extra food. Since the blood sugar came down so well this morning, I tend to think it was mainly the extra food.

If he goes low today, drop it down to 7 units and see if you can stick with that.

It is best at this point to ignore higher blood sugar for now - don't try to "fix" it with more insulin.

It is possible that he "rebounded" from going too low earlier in the day. When you got a reading of 59, he may have been even lower than that shortly before or shortly after you took that reading so could have been in actual hypoglycemia.

And the solution to avoiding rebound and the low blood sugar that causes it is to cut the insulin back and endure the higher readings that follow for sometimes as much as two days while his body gets back on track.

I'm glad you skipped the walk. Did he walk on Friday and Sunday? What time were his walks?

Just in these couple of days' readings, there's some inconsistency of response - Friday on 9 units was really great while Sunday on only 8 units was a much sharper drop. That's why I'm curious about the walk and when any walks occurred. You can have a dog who doesn't consistently "break open" the insulin so one day you get a curve that looks very different from another day. But the exercise could also be a major factor influencing the curve. Most of the time, I see exercise dropping the blood sugar. So any exercise that occurs has to be figured into these numbers.

Natalie

[Bnnclvr]

Natalie - I took him on 20 minute walks (10 minutes shorter than usual) Sat. and Sun. morning (wanting to see what his readings would be on a normal day). This morning he did not go for a walk. I thought diabetic dogs needed exercise. His readings this morning after 8 units at 5:45 am [and 8 units last night at 5ish]) were:

5:45 - 181
7:55 - 198
10:55 - 89

(they seem to be more level. I assume the insulin will peak around 11:45?)

Thanks for keeping up with me Natalie. Bonnie

[k9diabetes]

Exercise is a good thing... the only problem is that it can be kind of a loose cannon variable with diabetes and injected insulin until you work out what it does to his blood sugar. So when you're first trying to regulate your dog, sometimes it's just easier to leave it out of the equation. And it always has to be timed carefully.

Dogs are essentially like juvenile onset, insulin-dependent diabetic people. So you aren't really focusing, as Type II diabetic people often do, on obesity and improving the body's ability to use the insulin it produces with diet and exercise.

Dogs are like Type I diabetics - they don't make any insulin any more.

That means you have to replace this incredibly fine-tuned endocrine system that adjusts moment to moment to the amount of food and activity with a couple of injections of insulin a day, a diet that best matches the profile of the insulin absorption, and life!

Exercise for most of the dogs I have seen drops their blood sugar, sometimes quite sharply.

So the walk Sunday morning could have contributed to his dropping down to 59 and walks on prior days may actually have exhausted his supply of blood sugar... have you noticed him getting lethargic and really tired on a walk? If he goes too low, he may rebound - the body panics, appropriately, because the blood sugar is dropping below a safe level and tells the liver to dump some stored glucose into the system to save the brain and body. Saves the dog's life from a potentially lethal hypoglycemia but also causes "rebound" - that dump of glucose and the hormones associated it with it send the blood sugar way up with no compensating insulin.

Did he have a walk on Friday morning?

If not, I'd say the walks could be a big contributor to that low of 59 on Sunday. And the walk Saturday may have generated the higher numbers Sunday morning.

He could be rebounding or he could have just burned up a lot of insulin from the exercise, making it run out early. The faster the body uses it up, the less is available later.

So....

If you're feeling brave and you think Wiggins will cooperate, you can check his BG before you leave on a walk - make sure it's decently high so you're not risking a major hypo - and then take your meter with you and check his blood sugar after 10 minutes of walking and then when you get back from your walk and see what his blood sugar does.

Always take a syrup source on walks in case his BG ever goes low while you are out.

Chris' blood sugar could fall very sharply with any kind of activity. I sometimes gave him a tablespoon of syrup - he weighed about 60 pounds - before we left on a walk as that would get into his bloodstream immediately and not last too long but boost his blood sugar while we were walking.

Personally, I wouldn't go above 8 units and I might even cut back to 7.5 units so that he stays comfortably away from low blood sugar without you having to give him emergency food because you're worried.

If you can stay in that space - same amount of food and insulin every day - for about five days, you should then be able to do a curve and see where his blood sugar has settled on that regimen and then make decisions from there. For the curve, I'd opt to skip exercise so you can see just the food and insulin interacting. Then we can combine that curve and what you learn by testing him before and after (and maybe during) walks to see how exercise fits into the big picture.

Hope that makes sense!

Natalie

[Bnnclvr]

Natalie - your posts are like reading a book (an interesting book). I did take Wiggins on a walk every morning except this morning. When I was giving him 11.5 units of insulin, yes, he was pretty tired on the way back from the walk.

I just took his blood sugar at 1:00 pm (Denver time) and it read 102. Earlier it was:
5:45 am 181
7:55 am 198
10:55 am 89
now 1:00 pm 102.

That is with 8 units of insulin. I am going to take your suggestion of 7.5 units for the rest of this week. He really does seem to be evening out today without the walk. (He does love his walks.) I will wait until next Saturday, when I have time to test him, and possibly give him some karo syrup before we walk? It is nice to see his numbers basically between 100 - 200 (even though I think the one touch ultra measures high).

He gets his next insulin injection at 6 pm and I will test him right before to see where he is at. Thank you from Wiggins.

[k9diabetes]

Those are really beautiful blood sugar readings today!! What I would have given for Chris to get such a flat, lovely curve.

It will be interesting to see if he can hold in that range or whether he's going to bounce around some days.

You can see where, with blood sugar in this range, a sharp drop from exercise could send his blood sugar quite low.

I would give syrup, probably no more than a tablespoon, before you go walking.

The problem with giving something other than syrup is it has to be digested before he gets any use out of it so you'd probably be back from your walk before the glucose from the food got into his system. Syrup goes directly into the bloodstream - and hence it also doesn't last a long time either so you wouldn't see his BG rising hours later from it.

The human meters pretty much universally measure the blood sugar at or lower than the actual value. So most likely your readings are somewhat lower than the true blood sugar.

With Chris, our OneTouch Ultra was a pretty predictable 30-40 points low in normal ranges and it dropped down closer to 20 points at the low and high end of the the range. So if it said 60, I assumed it was no more than 80.

I can't say what you and Wiggins would get if you compared with lab values, which would be good to do at some point. But I think you can safely assume the readings are somewhat low.

Urine strips can help confirm that when you have blood sugar in this range. With a 181 and a 198, you would see virtually no glucose in his urine early this morning if the meter is right on (glucose spills into the urine above approximately 180) and somewhat more glucose in his urine if the readings are actually about 40 points low, so 221 and 238 instead.

You are doing great!! I'm so excited to see such good numbers!

Natalie

[pgcor]

Bonnie!!!! Those numbers are fabulous! You should be proud of yourself!!!

[Bnnclvr]

It's funny you should say that because I really am! Thank you for noticing :)

[peggy0]

Ok Bonnie. I'll send him a note and see if he can refer you to someone :)

[Bnnclvr]

Natalie - A bit of a scare this morning. At 4:20 a.m. Wiggins started drinking water excessively. I ran a blood test and his reading was 493. I am not walking him in the mornings per your suggestion (waiting until Saturday when I can check frequently) and am wondering if that is affecting his blood sugar reading? 493 is obviously too high, and I know my meter reads low. Any suggestions?

[peggy0]

exercise is like insulin; it drops their BG typically. If you were walking him when you did the curve and now you aren't, it could affect it, but I don't believe it would affect it that much. I would think its cutting back on the insulin if you have. Natalie will provide you with some good advice :)

[We Hope]

Bonnie,

Agree with Peggy that if you're at 7.5 units, it's not enough insulin. When that's the case, you don't always notice it in the form of high bg's instantly because after you've been using insulin regularly for a while, you build up a little "spare tank" of it called an Insulin Depot.

With the intermediate (Vetsulin and NPH are intermediate acting ones) and long acting insulins, your insulin depot has about a day's worth of insulin in it. This is there for your body to use when it needs some extra insulin. It's the reason why if you forget a shot or have a problem with one where all of the insulin doesn't go where it's meant to, that you don't need to go back to square one and start to regulate all over again.

http://www.childrenwithdiabetes.com/download/hanas_insulin.pdf

Pages 10 & 11-Insulin Depot

The insulin depot is why you don't see immediate results when you increase a dose and, as above, it's the reason why a missed dose doesn't mean starting over again.

Before Vetsulin was in the US, we used a similar product called Iletin II Lente. Not long after Lucky was nicely regulated on it, Lilly decided to discontinue the insulin. After that, we got 2 vials which came weak from the factory; they were about 45-50% potent.

When this happened, we didn't see any immediate changes in Lucky; his high bg's started about 2-3 days after going to the new (weak) vial. His insulin depot still had some "spare " insulin in it until that point.

Peggy is right that exercise does normally lower bg's (this is why they're always telling people with diabetes of both types to develop a regular exercise routine), but not walking shouldn't cause Wiggins to have numbers that high.

I'd say, from the previous readings you've gotten, that there's nothing wrong with the insulin itself, otherwise you wouldn't have gotten such nice numbers out of that vial. :)

If you're sure that Wiggins hasn't gotten into anything (eaten anything other than his food), then again, I'd say he needs to have more than 7.5 units per dose.

BTW--it will take you a couple of days to get Wiggins' bg's back to where you had them--the insulin depot again--but if you are consistent with his insulin, you shouldn't have a problem getting back to where you were.

HTH!

Kathy

[k9diabetes]

I think we will have to be careful here... at only 1/2 a unit less than the dose on the curve where the BG went down to 59 and 89 on the meter, we could have a rebound here rather than not enough insulin.

I think it's possible that Wiggins does not use the insulin consistently.

And with such a huge jump over only half a unit decrease in dose, a rebound seems at least as likely to me as an underdose.

From what I've seen so far, I am not sure it will be wise to run Wiggins' control as tight as the curve... I know that stinks but I am not yet convinced that his use of the insulin is the same day to day.

If it was me, I'd hold at 7.5 or drop to 7.0 and see what happens over the rest of the week. If there really was a rebound, his BG could be out of whack for a day or two.

Then, I'd do some spot checks of his BG in the evening. Start with a predinner test and check a couple of times... maybe at 2 hours and 4 hours after eating if you can. See if his BG is going low or staying high.

It is extremely difficult to tease out rebound from not enough insulin without tests throughout the day.

Natalie

[peggy0]

Bonnie

I Heard from my vet in Colorado Springs. Here is his note. Hope this helps you out.

Hi Peggy!

It was great to hear from you and it seems everyone is doing well. Love the pictures.

Diabetes is tough, it takes patience, and it always seems that something is upsetting the delicate balance. It sounds like Forbin is regulated now, congratulations. It takes a lot of work on your part.

For your friend in Denver, I recommend Veterinary Specialty Care Center (VRCC). Their web site is www.VRCC.com They have multiple internal medicine doctors as well as many other specialties. If they live on the south side of Denver, Colorado Springs is not a long drive and we have 3 great internal med. doctors (one who was in Dallas and I have worked with a lot - Dr. Brad Hines). Their web site is http://www.veterinaryspecialty.com/

I hope that helps, if not let me know, I will do what I can.

I miss all my clients and patients at Pet Care. However, I love living in Colorado Springs. We added to our family just over a year ago, a little girl that is growing way to fast.

Take care,

Rex

[k9diabetes]

I just saw an article in Family Dog, an AKC publication, one page on canine diabetes by Dr. Kevin Fitzgerald at Alameda Veterinary Hospital in Denver.

He answers questions and was writing about diabetes. He paid some attention to home blood glucose testing, along with aggressive management and a team effort. He was not specific about insulins.

new portable blood-glucose meters are now available, so owners can monitor their dogs without coming to the clinic. If capable owners obtain a blood-sugar meter that is simple to operate, home monitoring (along with once-weekly body-weight checks, the tracking of appetitie and eating patterns, and regular testing of urine specimens for glucose) can be a valuable tool in the management of dogs with diabetes mellitus. But be aware that home blood-glucose meters do not replace regular veterinary visits for evaluation of how well the dog's disease is controlled.

Natalie

[peggy0]

I love Kevin Fitzgerald and Alameda. Wish all veterinary places could be like that one

[peggy0]

checking in on Wiggins.............

[k9diabetes]

I'm glad to hear Fitzgerald has your support - I keep a little file of vets who are recommended and am always happy to add some to it.