Well regulated, suddenly unregulated ... suggestions?

[icaru]

Hi,

On March 5, 2010, our nearly-9-yr-old Maltese dog, Gigi, was diagnosed with diabetes and mitral insufficiency. She was exhaustively tested for Cushings -- negative. However, she is on heart meds: Fortikor and furosemide.

We live in Europe, vets in Europe use Caninsulin (Vetinsulin) almost exclusively (widely available here, no warning issued). The vets I have contacted (6 of them) have little or no experience with Humulin formulations.

Gigi weighs 9 pounds. She was started on 5 units of Caninsulin once daily. Within a few days it became apparent that she was rapidly metabolizing this insulin and the effect was gone after about 6 hours. The vet then reduced the dose and began twice daily injections, one every 12 hours with a meal.

At first the curve looked promising but once again, after a few days we saw wild swings in the space of 6-7 hrs: from 120 to 400+. After 4pm (7 hrs after injection), her BG value was/is always over 350 until the next injection takes effect.

We decided to try Humulin N. Our vet agreed to try it but admitted that he has never had experience treating a dog with human insulin.

After a week of 'start low, go slow' we again reached 4 IU twice daily = 8 units of insulin for a 9-pound dog. It's a lot! But alas, same problem. From about 4pm until the second injection takes effect around 11pm, her BG values are in the 300 - 400s. IOW, she quickly metabolizes whatever insulin she receives, and the effect is gone. We are unable to extend the duration.

We tried increasing the dosage - at first with Caninsulin, later with Humulin. Both times we got the Somogyi effect. Her BG went down to 40 then shot up about 100 mg/DL per hour until it leveled off above 500.

The vet tells me he has never had a dog as difficult to regulate as ours. The dog has now been in and out of the vet hospital for over 10 days trying to find a smooth curve but so far no luck.

We've two questions:

1) Has anyone else had a similarly difficult experience in regulating their dog, and if so, what worked? Should I try a mixture of N and L? I read that L is not very effective for dogs.

2) Although we have a glucometer, we have let the vet do the glucose curves because we are only able to draw blood from Gigi's upper lip. To get 7 readings in a day we have to prick her lip(s) an average of 10 times during the day. We tried unsuccessfully to draw blood from the pinna of her ear but only once we got enough blood for a reading. Even warming the ear with hot water and rubbing it doesn't work. The vein is tiny, collapses and it clearly hurts her when lanced. So we've given up on the ear. I read that some people draw blood from the base of the tail. Our vet told me not to do this for fear of infection.

What have people with very small dogs found to be an effective technique to get enough blood for a glucometer?

Any experiences you have to share in regulating an insulin resistent dog and / or successfully drawing blood from elsewhere than the lip will be greatly appreciated.

Carole

[Patty]

Hi Carole and welcome!

Can you tell us what food Gigi is eating? Has she always been on this food?

Sometimes tweaking the diet can help with altering the shape of the curve and extending the duration of insulin. Other times it truly is the way the body is handling the insulin.

I think Natalie's experience resonates closely with your story and I'm sure she'll be along to help as well. Have you read the case study of her dog Chris? http://www.k9diabetes.com/storychrisk.html

Humulin L is no longer in production. I know some of the insulins have different names in Europe. There are some people that use Humulin R (called Humulin S, for "soluble," over there) http://petdiabetes.wikia.com/wiki/Humulin_S to bring down post meal spikes or to cover a short period of time where the longer acting insulin has faded. But you'd definitely want to be able to do a lot of testing.

Another option is to give the NPH 3x a day to cover the gap where blood sugar is rising.

As I said Natalie has some experience with this so I'll let her address those options with you.

There are some people that test the base of the tail with great success as well as the carpal pad. I think Heidi is one of those that have used these places on her dog. I'll see if she can comment.

Take care,
Patty

[k9diabetes]

Hi Carole,

Please post the results of curves you have had done in addition to telling us more about her food.

I'm not concerned about her dose - 1/2 a unit per pound per injection is fairly common.

The main tools you have to improve regulation are the content of the diet, how often you give food, and how often you give insulin. If someone is home with Gigi most of the time, you have the most options because you can give more meals and/or more injections.

So if we can take a look at her curves, we can see what might work to improve them and talk about what's possible for you given your schedule.

I think the back at the base of the tail would be an excellent place to test Gigi. I know many people who have used this spot for years. The carpal pad is another possibility.

Natalie

[BestBuddy]

Carole,

Hi and welcome. Don't worry about the insulin dose, it's still in an average range. My Buddy was just over 5kg (around 11 lbs) and he got 4iu twice a day. The specialist said that all the diabetic dogs he was treating at the time were all getting their weight in kg in insulin units!

Jenny

PS 9lb is 4.08kg:D

[CarolW]

To Carole from Carol - a big, fat welcome to you and Gigi! I LOVE Maltese!

You said Gigi was diagnosed on 5 March - well, that's only a few weeks back; it can take time to work out how to regulate a dog on insulin, especially when you have the other (here, heart) complications as well. And food makes a big difference, too - adjusting that really can help.

I DO like the human insulins for dogs; my Kumbi is on Novolin-NPH, which I think is like the whatever-it-is-Humulin you have over there in Europe.

Kumbi has been on this from the start, well over three years ago, and it took us more than a year to get him regulated. He was okay in the meantime, just had his numbers jumping around a lot - but he never got into rebound, nor had a hypo.

I trust if you changed to human insulin, you also changed the syringes you use, from Caninsulin ones to human ones, right? You'd have to, to get the doses right.

I see you're getting all kinds of really useful help here; why am I not surprised? I'm looking forward to seeing Gigi's curve numbers.

Oh - about prick-site for testing - I use Kumbi's "lip" I alternate sides, usually, and by the time a curve-day is over, his mouth has lots of holes in it. He's probably somewhat bigger than Gigi, almost twice her size, but I think i'd be able to find room for those 10 to 12 pricks in a day, without really wrecking the "lip." You can prick fairly close to a previous prick, I think. I love the lip as a prick-site, because it doesn't hurt the dog, and I think it's very efficient; tends to bleed easily (Kumbi doesn't, though, so I warm the area first, by folding his lip down over a very-warm wet paper towel.)

I have pictures and descriptions here:

http://www.coherentdog.org/vek/bgtest.php

I did consider trying other prick sites for Kumbi, but prefer the lip. It heals up fairly quickly. So maybe you'd want to try that again, after all. I wonder about the base-of-tail - is your vet aware that's done on the BACK, not to the side, nor under the tail? I too would worry about possible infection in such a situation. I'd think on the back would be safe, though.

Tue, 30 Mar 2010 20:07:36 (PDT)

[icaru]

Thanks to all of you who have answered my post about Gigi. Re food and curves ...

By the time Gigi got the final diagnosis (Cushings or diabetes), she had lost 25% of her body weight and was a little bag of bones. On March 5 when we received the definitive diagnosis of diabetes, she got her 1st insulin injection of 5 IU of Caninsulin.

She had a very bad reaction 15 hours later. It started at half past midnight. Not knowing what was happening -- I thought maybe a hypoglycemic reaction -- I gave her Nutrigel. This might have been a big mistake. We both went through a night of hell.

She arrived at the vet clinic at 9 am in a ketotic state, nearly dead. By a miracle, she survived. We still don't know what happened that night. I suspect a delayed reaction to a high first dose of insulin but the vet thinks it was probably a heart problem. Whatever, it totally changed her food habits.

Before she was eating Royal Canin Sensitivity Control (has allergies, this was the only food she could eat and not scratch. Cannot eat foods with beets, beef, lamb or wheat).

Following the start of insulin injections, for a week she lived only on Virbac Nutrigel (soya paste). When she started to eat by herself again, she refused everything except ... scrambled eggs ! She even refused her most favorite thing, steamed chicken breast. We have tried every kind of diabetic food, she won't touch any of them. Won't even eat what she used to eat, RC Sensitivity Control.

After about 1 week she began eating a little but only scrambled eggs and tuna fish. Slowly that is changing. After 3 days of that, she refused tuna and we went back to chicken, cooked oatmeal, brown rice and scrambled eggs (no oil, salt or anything, just egg). Then she refused to eat if oatmeal was mixed in.

Now I am trying to reintroduce kibble. She likes RC Weight Control which is also glucose regulating. Here is what she currently eats twice daily (2 meals, 2 injections, each 4 IU Humulin N):

50 grams chicken breast cooked in a bag, i.e., like steamed.
70 grams scrambled egg & kibble omelet. 200-230 grams/day of food (I weigh and record everything she eats).

Prior to her diabetes she was eating 120 g kibble daily. She is now eating much more, probably due to the severe weight loss following her diabetic onset.

I grind up the kibble and add it to the eggs while cooking to make a kibble omelet. Sometimes I add a bit of cooked brown rice which has a low glycemic index (white is high, brown is low).

She will not eat anything else for now except sea biscuits as a treat, 2 / day (dried codfish skins, made into cubes. 85% protein).

Re curves, we have only done 1 curve as pricking her lip 10 times that day was excruciating for us, more than for her. The vet has done all of the curves (vets much less expensive here than in the US).

He gets everything from smooth in the beginning to Somogyi effect yesterday. The only curve we did at home clearly shows a Somogyi-like effect. That was done on the day I tried to raise her Caninsulin shot from 3.3 to nearly 4 IU. http://marbella-apt.com/Gigi_BG_curve.jpg.

In addition to this curve, I have kept a detailed record of food eaten, meds given, insulin injected, urine glucose and a smattering of BG readings taken when we suspected hypoglycemia. In fact, once we found her BG at 40, we gave her Nutrigel and some honey, it then went to 506 !

Those of you who do or did daily curves, how many times per day did you prick your dog's lip? This is the main reason we have asked the vet to do the curves as they draw blood directly from the jugular vein.

He told me last night he has never had a dog so difficult to regulate. Tomorrow we bring her home for good. After that we are on our own to continue testing and trying to regulate her.

So we welcome all suggestions ! Greatly appreciated.
PS. Yes we are using 100uL syringes with Humulin, 40uL for Caninsulin. Lilly says Humulin does not need to be refrigerated but we are doing it anyway.

Also, Humulin L (lente) still exists on the market.

[Patty]

Hi Carole,
Just a quick note...I'm wondering if we're talking about the same insulin when it comes to Humulin L?

Humulin L[2] was a U100 r-DNA/GE/GM intermediate-acting, lente insulin[3][4][5]. Novo Nordisk also made similar insulins, calling them Novolin L[6] and Monotard[7][8].
"L" came to an end when Eli Lilly announced in July, 2005 that it would no longer be produced[9][10]. The UK & Euro production of Humulin L stopped a year prior to this, in July 2004[11][12]. http://petdiabetes.wikia.com/wiki/Humulin_L

INDIANAPOLIS, July 6, 2005 - Eli Lilly and Company (NYSE: LLY) today announced that it is discontinuing production of Iletin® II Pork Insulin (Regular and NPH®formulations), and Humulin®U Ultralente® and Humulin®L Lente®(Humulin U and Humulin L) insulin products. Given current inventories and patient demand, these products should be available in pharmacies through the end of 2005. http://newsroom.lilly.com/ReleaseDetail.cfm?ReleaseID=168048

Patty :)

[ozzi]

Hi Carole,

I would like to help you but I feel others here are way more able to do so. To me however, the severe BG drop over the first 4 hours looks like Gigi is metabolizing the insulin too quickly, resulting in rebound. I wonder if it would help to back off the insulin from 3 units to 2 1/2, to see if you get a better response. That would be my thought, but I would wait until you hear from others to see what they think.

Regarding home testing, there are several sites where you could test Gigi if you're concerned about always pricking the lip. Ozzi refuses to let me take blood from his lip, not that it hurts, he just doesn't want anyone in his face! I use his elbow callus. Others use the area just above the tail, or the paw pad. You can get many ideas from the videos and resources here. So you are not limited to the lip. Having said that, from what I have read, the lip has fewer nerve endings so apparently it's not so painful, even though WE think it is!! Personally, I think it's the best location, and wish I could do that, so you might be okay taking it from her lip each time, especially if you are successful doing so.

Regarding the number of times to test when doing a curve, it's best to take the first morning (pre-feeding, pre-insulin) blood test, and then test every 2 hours as you did, over a 12 hour period. It's nice to get a 24 hour curve if that is possible, but most people seem to do 12 hour curves to get an idea of how their dog is metabolizing insulin.

Good luck and keep us updated!
Kevin

[icaru]

Patty, you are of course correct about Humulin L. I was reading an old page from Lilly but in fact, it is no longer on the market in Spain either.

[Chloe's Mom]

Hi there Carole!

First off, welcome to this group. There are lots of great people here to help you.

I wanted to tell you that I test on the carpal pad of my Westie, Chloe. I tried the lip, but she would not have it. I did use the base of the tail, but to be honest, I really felt I was hurting Chloe every time because I had to use a very heavy gauge lancet in order to penetrate the thick skin that she has in that area. The carpal pad was the answer for us. It is almost painless. My girl is standing up on a table when I take the sample, but there is a video on photobucket where the dog is lying down. Either way works. Another good tip that I found works to get the blood flowing is to put a heat pack on the area for about 10 or 15 seconds, then gently massage the leg. Chloe loves that part, LOL. I will try to find the link to the video and post it.

Anyway, for us this is the way to go. Every dog is different in what they will tolerate, so you just have to try alternate sites until you find what works for you and your dog.

I hope this helps in some way, but I know you can do it!

Hugs,
Heidi and Chloe

[Patty]

Hi Carole,
Boy you've had a time of it with food. I can sympathize to some extent. Luckily, my dog will eat most anything but has significant allergies that limit what I'm able to use with her. It can be frustrating to find something that works.

So that curve was on Caninsulin at just under 4units on March 17th? Do you have one you could post from the vet on the current Humulin N? What is her current dosage? I know she is at the vet's for testing now.

I printed out your post so I could read through it better. A couple of thoughts I had...

- What are the ingredients in the Nutrigel paste? This was the closest I could come up with in a websearch http://cebuvetdoctors.com/virbac-animal-health.html But the ingredients aren't listed.

- It's great she's willing to eat some food with a bit more fiber in it to help with the insulin. I do know someone else who used to grind the kibble and added it to canned to make "meatballs" out of it due to trouble with her dog's teeth. But I almost wonder if grinding it to add to the eggs allows it to be digested too quickly. Whereas the kibble pieces take longer to break down and help balance the peak of the insulin.

- You said you've added some brown rice to her food in the past. I think white rice may potentially be a better choice for her as it gets into the system quicker and may help prevent the fast drop. I've used medium grain sushi rice before. You'd want to rinse it before cooking to remove excess starch.

I'm glad you're recording everything. That's so helpful for going back to see what has or hasn't worked.

You asked about how many times were needed for testing bg (blood glucose) in doing a curve at home. You were right when you said 7 for doing a 12 hour curve. Typically most people will start at premeal fasting then every 2 hours until evening fasting time. Sometimes with a quick drop in blood sugar, hourly around that lowest point of the day can be helpful to find out exactly how low the dog is going before rising again.

I think if you can get a hold of her most recent curve from the vet's office along with what food was given that day to post here we could help make some more specific suggestions.

Take care,
Patty

[icaru]

Hello Patty,

We brought Gigi home today. The vet showed us her BG readings for the last couple of days. She is now on 5 units of Humulin N twice daily. Her readings today were:

March 31:

9 am = 226 mg/dL ( injection given without food today - she wouldn't eat until 11 am)
11 am = 46 mg/dL (ate now)
1 pm = 117
3 pm = 337
5:30 pm = 196 (went down, why?)
8:30 pm = 224
dinner at 8:45 pm
injection @ 9:15 pm
11:15 pm = 99

I am hoping to slowly get her off scrambled eggs and back to whole kibble. Re rice, if you look at the glycemic index of rice, white is the worst. It gives the highest glycemic boost.

"The glycemic index of food is a ranking of foods based on their immediate effect on blood glucose (blood sugar) levels. Carbohydrate foods that breakdown quickly during digestion have the highest glycemic indexes. Their blood sugar response is fast and high. Carbohydrates that breakdown slowly, releasing glucose gradually into the blood stream, have low glycemic indexes."

I had read that Basmati brown is the lowest of the rices, i.e., raises BG the least of all rices. So I bought Uncle Ben's whole brown rice. However, now on another site I have read something else interesting:


"Brown rice has a lower glycemic index than white rice, everything else being equal. Therefore brown long-grain rice—or if you can find it—brown Basmati rice—will probably have a lower glycemic index. White Basmati rice had a glycemic index of 83 in one study. Brown Basmati rice can be expected to have a somewhat lower index, but we don't know precisely what it is, because the studies haven't been done yet.

In fact, however, Uncle Ben's Converted Rice is the lowest glycemic rice you can get. This is white rice. Jennie Brand-Miller has indicated to me that this company may use a secret process. "
The Glycemic Index (http://www.mendosa.com/gi.htm)

Virbac Nutri-plus Gel ingredients: soya oil, cod liver oil, molasses, malt syrup, meat peptone, glucose, sodium benzoate & purified water. This product is sold in the US as a nutritional supplement under a different name. Here it is used when a dog doesn't eat or needs a fast energy supplement, for example, in a hypoglycemic state.

Thanks for your help and support.
Cheers, Carole

[Patty]

Hi Carole,

You are right. White rice has a higher glycemic load, which typically is not something you look for with a diabetic. However, if you are getting a steep drop in blood sugar, you'd want a food that will get into the system faster than what a complex carb will and has a higher glycemic index to prevent the drop in blood sugar. When using rice, I'd also look for an unenriched brand. The trick is trying to balance the peak of the insulin. ;)

It is hard to see a true picture from today's curve since she had insulin without food. :o Do you have a prior curve from one of the days where food/insulin were matched?

Glad Gigi is back home :)

Take care,
Patty

[k9diabetes]

Hi Carole,

Well, when I saw the curve you posted on Caninsulin, I had one set of recommendations but I'm pleased to see that her reaction to NPH seems to be much much better.

Probably part of the problem with the Caninsulin was that she has been eating a mainly protein food - it takes a while for protein, like an egg, to be digested so there would have been a serious imbalance between her food and insulin.

March 31:

9 am = 226 mg/dL
( injection given without food today - she wouldn't eat until 11 am)
11 am = 46 mg/dL (ate now)
1 pm = 117
3 pm = 337
5:30 pm = 196 (went down, why?)
8:30 pm = 224
dinner at 8:45 pm
injection @ 9:15 pm
11:15 pm = 99


This curve is a huge improvement over the prior one you posted.

One thing to consider is that dogs process these insulins somewhat differently than people do. And then there's the variation dog to dog, which can be huge. You can take two dogs on the same diet and the same insulin and one will have a curve that's a valley and the other will have a curve that's a mountain and a third dog will have a doulbe humped camel curve!

As a result, some dogs actually need some readily digestible carbs to match a fast strong surge of insulin.

That would have been my recommendation if she was still plunging from 500 to 100 in the first couple of hours after injection - adding some readily digestible carbs like white rice AND perhaps delaying injection her insulin until 30-45 minutes or more after she ate, depending on how much the white rice or other carb helped.

But the great news is that this curve looks pretty good. The NPH is having a much gentler effect and is better matched to her meals. Even though she didn't eat right away, she didn't drop nearly as sharply and she didn't climb up sky high either.

You asked why her blood sugar dropped in the afternoon.

There's a constant interplay between food and insulin and any time one gets ahead of the other, you get a large change in blood sugar. If the food gets ahead, the blood sugar rises. If the insulin gets ahead, it drops.

So in the afternoon you can have a time when the food had been pretty much all digested and converted to glucose in the bloodstream. Once the food was all gone, there was enough insuin still active in the system to actually reduce the blood sugar. It's fairly common for NPH to give the lowest blood sugar at 6-8 hours.

I think this is encouraging!

Then if you can do a curve at home, we can see how it holds up to better conditions and a proper breakfast.

I suspect Gigi might prefer a few pokes in the lip at home to having blood drawn from a vein. Our dog was patient with that but it didn't look like much fun for him. I'm sure he preferred a quick lip prick.

I hope her eating settles down. Refusing foods they used to eat well can suggest that they don't feel well. We went through a lot of different foods with Chris for a while.

Natalie

[icaru]

Hello again,

We switched from Caninsulin to NPH 8 days ago (March 29). We are still seeing a morning dip into hypo range, 40 or less, although Gigi doesn't seem affected by it. But I've had to give her something to eat 3 or 4 times now.

Two vets and we have concluded that in the morning she is processing the insulin much faster than the food, so now she eats and I wait from 45' to 1 hour to give her the shot. We also think that a walk 2 hours after the shot sends her glucose lower, so we have adjusted the time of the walk too. This morning, April 6, she did not have the hypo dip but both her BG and urine glucose values are very inconsistent. (See charts below).

However, I have another question for all of you. Gigi lost a lot of weight before she got onto insulin. Although she is now eating more than before, her weight is stable and her stools are not as firm as they should be. But she is energetic and behaves very normally. I would like to put more weight on her but how? I tried adding chicken fat to her food, she vomited. She is still insistent on having steamed chicken breast and a kibble omelet. If I put in too much kibble, she won't eat it. I noted that several people are feeding beans for fiber. I'll try this but wish me luck as I doubt she will eat them. Gigi has become very fussy about food lately!

Do any of you use pancreatic enzymes to aid digestion? It is common for dogs with diabetes to have EPI. I am now using Prozyme but that is not the same as real porcine pancreatic enzymes.

Thanks and best wishes to all dogs and owners, Carole
---------------------

http://marbella-apt.com/gigi_mar_31.jpg

http://marbella-apt.com/gigi_apr_1.jpg

http://marbella-apt.com/gigi_apr_4.jpg

[k9diabetes]

However, I have another question for all of you. Gigi lost a lot of weight before she got onto insulin. Although she is now eating more than before, her weight is stable and her stools are not as firm as they should be. But she is energetic and behaves very normally. I would like to put more weight on her but how? I tried adding chicken fat to her food, she vomited. She is still insistent on having steamed chicken breast and a kibble omelet. If I put in too much kibble, she won't eat it. I noted that several people are feeding beans for fiber. I'll try this but wish me luck as I doubt she will eat them. Gigi has become very fussy about food lately!


Whenever I wanted Chris to gain weight I just gave him more of the food he was already eating. Usually I increased it by about 20-25%.

And then you probably will have to increase the insulin a little bit but you usually don't have to increase the insulin very much. About half of the insulin goes to their "basal" needs - need for insulin even if they don't eat. So only half of the dose is directly related to the diet and then a small increase in quantity usually means just a minor bump in the insulin.

Natalie

[icaru]

Over this first month of BG testing using the Accu-Chek Aviva system (tests 99% correlated with lab values), we have seen several strongly hypoglycemic values but our dog Gigi has always been asymptomatic!

I just returned from a rather long walk up and down hills, she showed no signs of hypoglycemia but on arrival at home her BG was 1.4 mmol = about 19 mg/dL ! We checked it twice in two different spots and calibrated the meter too, all correct.

I gave her two big licks of honey, will test again in 20' but wonder if others have seen these extreme lows with no visible signs of hypoglycemia? She is lying beside me, barking at noises, perfectly alert and normal!

30' later: same reading. Tested myself, my reading is high normal range, meter works. Gave her big glob of Virbac Nutrigel Plus as honey does not seem to have increased her BG value.

55' after 1st reading: up to 50 mg/dL, hopefully still rising.

1 hr 20' after 1st reading: went down again to 34.2. Gave her another big glob of Nutrigel Plus and her dinner + extra carrot + skimmed milk (read this is good for hypo states).

Re the meter, I did not check against the vet's because I am more interested in internal comparisons, i.e., my dog's readings on my meter. I read today a very thorough evaluation of this meter as compared to human blood values measured with lab equipment. This report was prepared by the British National Health Service to evaluate the precision of this glucometer to decide if it meets the standards for the NHS. The Aviva meter correlates very high with the lab readings in humans, after that, it is not important for me to know if it correlates well with my vet's reading as he doesn't do any readings anymore.
----------------------

YEAH ! Out of the danger zone. 2 hrs 20' later, after dinner, skimmed milk, carrots, honey + Nutrigel she reached 223 mg/dL. A little high but pre-shot so at least I can now give the insulin shot.

Lesson learned: don't exercise Gigi more than usual. Causes big drop in BG.

[Patty]

I would also give her some food for a longer lasting effect and reduce her insulin tonight.

Some dogs don't seem to show obvious signs of hypoglycemia at lower levels for some reason.

I know you said the research on your meter is said to be fairly accurate. But I'm wondering if you've compared it to a lab draw at your vet's. You'd test as you normally do at home and the vet runs blood on his lab machine to find the difference.

My meter is about 30 points low in the lower blood sugar ranges. So it's possible her blood sugar is actually a bit higher.

Dog's red blood cells are a different size than ours so there is a difference between the results a human will get and that of a dog.

Glad you were able to test her!
Patty

[icaru]

After reading here that d-mannose helps to prevent UTI infections I bought some, but then read that it is a sugar and will alter BG values, contributing to hyperglycemia.

The d-mannose itself came with instructions NOT to use it together with cranberry. I note that most of the vet dog foods like Royal Canin, Hill's, etc. add cranberries to those diets.

So my current thought is to stick with cranberries rather than d-mannose. Anyone have any experience with this, for example, by how much it raises BG values?

[Patty]

Hi Carole,
I merged your threads so we'd have all of Gigi's info and questions in one place. It makes it easier to go back and look through when questions come up.

I do have information on D-Mannose powder and cranberry. I use both with my dog Ali. I will pull those links later for you.

So glad Gigi turned back upward for her shot time :)

Take care,
Patty

[Patty]

After reading here that d-mannose helps to prevent UTI infections I bought some, but then read that it is a sugar and will alter BG values, contributing to hyperglycemia.

The d-mannose itself came with instructions NOT to use it together with cranberry. I note that most of the vet dog foods like Royal Canin, Hill's, etc. add cranberries to those diets.

So my current thought is to stick with cranberries rather than d-mannose. Anyone have any experience with this, for example, by how much it raises BG values?

Hi Carole,
I went back and copied a post I made to another member some time ago on D-Mannose and cranberry for information...

"The cranberry powder you are using is good. The ingredient in it that helps keep the bacteria from adhering to the bladder wall is D-Mannose. D-Mannose is a simple sugar that is related to glucose but is processed differently by the body. It goes straight to the bladder where the bacteria prefer to bind to the D-Mannose than the bladder wall.

This is an excerpt from Wikipedia:
"90% of mannose ingested is excreted unconverted into the urine within 30 - 60 minutes, with 99% of the remainder being excreted within the following 8 hours. There is no significant increase in blood-glucose levels during this time." http://en.wikipedia.org/wiki/D-Mannose (http://en.wikipedia.org/wiki/D-Mannose)

I have not seen a rise in Ali's blood sugar using this. I use a combination of D-Mannose and cranberry powder for this reason:

"Although D-mannose is found in cranberries, cranberries don’t contain enough of the sugar to have the same effect. At the same time, cranberry extract contains proanthocyanidins that also prevent E. coli from adhering to the urethra and bladder.5 Cranberry extract also has a potent immune-stimulating effect. The two, when taken together, produce a beneficial synergistic effect on the urinary tract system." http://www.smart-publications.com/ur.../d-mannose.php (http://www.smart-publications.com/urinary_tract/d-mannose.php)

Now when she's had an infection, I don't use this in place of antibiotics. But definitely keep her on this for prevention/help eliminate the bacteria. The holistic vet I consult with approved this dosing advice: 30mg/lb of dog twice a day. So if Lucy's 22 lbs, that's 660mg twice a day. I buy mine in powder form and measure it out.

Now the gal I told you I was corresponding with just gave me some additional information. Her dogs weigh between 19-24lbs. She gets the D-Mannose in 500mg capsules and sprinkles one over their food. During an infection, she does this 4-5 times per day. Her info came from a chat forum with a doctor from New Zealand who was part of a control group study on the effectiveness of D-Mannose. For maintenance, she does this once, last thing of the day after they've been out to potty so it stays in the bladder longer over night. The 4-5 times a day during an infection makes sense since most of it is excreted every time they potty anyway.

I've stuck to twice a day maintenance dose only because it has been working for us so far. But if she has another infection I will increase the frequency."

I can tell you Ali just had another urine culture done and has been UTI free since December of 2008 (she had 3 UTIs in a row, all different organisms which is what prompted me to seek out some sort of prevention). I'm not saying it's fool proof, just that it seems to have helped us.

Cranberry powder does have the potential to lower urinary pH, so I would want to know what the pH of Gigi's urine is so you aren't lowering it too far and creating the potential for calcium oxalates. Urine pH is lowest in the early morning hours.

This is the D-Mannose powder I use if you want a comparison: http://www.nowfoods.com/Products/M035636.htm
This is the cranberry powder I've been using: http://www.smartpakequine.com/ProductClass.aspx?productclassid=5300&cmPreserveSource=true&cmPreserveCategory=true

I've encountered 3 or 4 people that have used D-Mannose with their diabetic, so far I haven't heard of any increases in blood sugar as a result.

I'm curious to know what brand of D-Mannose you have. Is there a website for it? I've not heard of one stating that you can't use it with cranberry before. I'd love to read more.

I hope that helps some!
Patty

[k9diabetes]

Exercise tends to drop the blood sugar sharply. You can give her a very carby, readily digestible snack before you walk her so that she has some extra glucose in her system. That should help keep her blood sugar more even.

Do take syrup with you on walks too just in case. We used to keep a little bottle of pancake syrup in a fanny pack or over-shoulder bag. Without symptoms at those levels, she could go into a seizure before you realized her blood sugar was low!

I hope the meter is in fact reading her blood sugar lower than it actually was. Basically nearly all human meters read a dog's blood sugar somewhat lower than normal and the amount varies quite a bit from meter to meter. Some meters can be as much as 100 points lower than the actual blood sugar level while others will be within 10-30 points lower.

With our 60 pound dog, our Accuchek Advantage was about 60 points lower than actual while our OneTouch Ultra was only about 35 points low.

Natalie

[icaru]

Hello Natalie,

Before purchasing a glucometer I read a few clinical evaluations of performance. At low values, most clinically acceptable portable glucometers are within 10% of the value obtained in a lab. The AccuChek Aviva is within 1% at the low, 3% at the high end. It is at the upper end that meters vary the most. It is also in the strips that more variance is seen.

When the vet had Gigi staying in his clinic, he did see several hypos but he said they did not go below 45 mg/dL. Howver, they were not taking her for walks, she was mostly in a cage !

The day after our 'long walk' that produced the 19 mg/dL reading, we then tested her before and after our standard walk. We were surprised to see that a 15' walk took her BG down by about 90 mg/dL but not necessarily into a hypo range. Now we are are very careful about the time of day and distance we take her. We try to take her when we know her values are above 180. As we are only 40 days into treatment, her BG values still have large swings during the day, but not as wide as in the beginning.

Re quick-acting glucose, I imported from the UK a diabetic product called GlucoGel. It is a small tube of glucose I carry in my purse. (http://www.chemistdirect.co.uk/glucogel-triple-pack_1_5895.html.

Patty, thank you very much for all that info re d-mannose and dosage. I decided I would use it together with the cranberry gel cap she is already getting. We do use 1-2 urine strips daily and they also check pH. If anything, Gigi's tends to be on the high side.

Re d-mannose, I got this from: http://www.waterfall-d-mannose.com/

I think the quote below is why the package of d-mannose says NOT to mix the powder with cranberry juice (this is their opinion):

"For example, we discovered, despite the common myth, that cranberry juice makes things worse for most people, because E.coli can metabolise the hippuric acid that cranberry puts into the urine. So basically, cranberry feeds the bacteria.

Incidentally, Waterfall D-Mannose comes from sweet European forest timbers, not from cranberries. You don't get mannose from cranberries despite some unethical companies trying to make that association (because of the myth that cranberry juice or tablets is useful against UTIs). In fact, most cranberries contain absolutely no d-mannose. Some very ripe cranberries at end of season may contain trace mannose, but not nearly enough to make it financially viable to extract it. We worked out that it would take tons of fresh cranberries to make a small packet of d-mannose of an alpha:beta ratio that would probably not be the optimum."

[k9diabetes]

The human meters read a dog's blood sugar lower than actual because the blood cells of dogs are not the same size as those of people. Meters meant to be used with pets use a separate algorithm to calculate the blood sugar that takes that difference into account (though they too can be off).

I think the Accuchek meters tend to be very good as far as consistency and accuracy of results. They just haven't fared as well in reading a dog's blood sugar accurately. I am guessing that the differences in how meters read animal blood is related to the screens in the strips and different ways they measure the blood sugar. OneTouchs, for whatever reason, have a really good track record with dogs and Freestyles have a really good track record with cats and small dogs.

The main reason I didn't use the Accuchek Advantage was it took a LOT of blood. I had forgotten how much more until I took it out to do a comparison after using the OneTouch for a long time. Wow! No wonder I had trouble home testing blood glucose at first!

Natalie

[icaru]

That makes sense Natalie. Two of the reasons I chose the Aviva system are that it requires only a 0.6 ul blood sample - very small drop -- and gives the answer in 5 seconds (less important). It also advertised having the least painful lancet. Gigi being so small does not tolerate even the finest of hand lancets poked into her anywhere but accepts the Aviva pen lancet in the lip with no protest. The readout is plasma-adjusted from the whole blood sample.

Here is some interesting data on Roche's site - as you said the Freestyle does look good, maybe worth switching to it:

Competitors
One Touch Ultra
• 1 μl, 5 secs - fairly large blood drop
• launched 2003

Freestyle
• 0.3 μl, 15 secs - very tiny sample - GOOD
• launched 2000

Ascencia Contour
• 0.6 μl, 15 secs - drop same as Aviva, test time longer
• launched 2003

[icaru]

Our Maltese, Gigi, was doing great, very stable and well regulated on NPH at about 4.9 units 2x daily. On June 27 I opened a new bottle of insulin. Within a couple of days I began to notice that her eyes were much pinker than usual, we started to do random blood samples and found wild extremes, similiar to those we saw at the beginning in March.

Nothing else has changed, only the new bottle of insulin. Today I've gotten readings between 76 when she woke up this morning (12 hrs after last night's injection) to 306 four hours after this morning's insulin injection! The insulin does not seem to be bringing her BG down, or at least much less rapidly than it was up to a week ago.

Any suggestions? Should I wait 2-3 days and keep monitoring it? Should I open a new bottle of insulin? Should I give her more or change to a very different injection site?

[Joan]

If you got a 76 reading before her breakfast and insulin shot, and she went up that fast I would say she is rebounding. Sometimes when you open a new bottle, you will find it is a bit more potent than the last, and esp if you have used the previous one past the 30 day mark or so. So I would certianly NOT up the dose, but rather decrease it by maybe 1/2 unit, or even add some carbs to the food and leave the insulin where it is.

It is good that you are testing, and can find these results. 76 is pretty low for a fasting reading....that is the reading at the end of the 12 hr cycle. She is doing very well for having been diagnosed in March just 3 months ago. When did you open the last bottle of insulin? It is a good idea to keep track of that if you dont already. Once you either tweak the food or reduce the dose, it would be very helpful to take some bg readings throughout the day at the 2 hr, 4 hrs, 6 hr mark and even 8hr till you find out how she is utilizing the insulin. If you can post those readings, there are many here who can help with the regulation.

BTW it is not unusual for a dog to experience variations early on after diagnosis. But my guess would be that the new insulin is stronger than the end of the old bottle. I also have a small dog, and I end up using a bottle only 4-5 weeks, and then opening a new one to keep it more equal. JMO

Hope you get this figured out, Hugs Joan

[Patty]

I like Joan's suggestion of reducing insulin a bit to see if rebound in the issue. Some bottles will be a bit stronger than others.

If that doesn't work then you could go through other possibilities such as UTI, etc.

Patty

[eileen]

I also agree with Joan's suggestion of reducing the dose of insulin to first rule out possible rebound.

I know of some who will actually automatically reduce by 1/2u whenever a new vial is started.

I used the Accu Chek Aviva for about 1 1/2 years with Mildred until switching to the Freestyle and now have settled into using the Alpha Trak.

On another note....if you like the lancing device that comes with the Accu Chek then just continue using it even if you switch meters as there is no reason you must use the device that comes with any particular meter.

I prick Mildred by hand without the use of a lancing device but have found the Freestyle 28g lancets to work best with Mildred so even with using the Alpha Trak I continue to buy the Freestyle lancets.

[Patty]

Carole,
I too wonder how long the last bottle of insulin was used. It may have lost some potency.

Also here's a good link for rebound if you haven't already seen it: http://www.caninediabetes.org/pdorg/somogyi.htm
Patty

[k9diabetes]

I agree with reducing the dose a bit and seeing whether that levels things out.

If she did rebound, it could be 2-3 days before her blood sugar gets back on track so you want to hold the dose steady even if her blood sugar is higher than you would like.

In the end, it may not be rebound. Could be this bottle of insulin is acting different than the last one. Do you have any left from the previous bottle?

We always kept a bit from the prior bottle as a backup in case we dropped the current bottle and broke it and also for times like this when we wanted to determine if the new insulin bottle was the problem.

So if you still have any from the last bottle, you could switch back to it or you could try a different bottle and see if you get the same thing. If you use another new bottle that you have never injected from before, I would stick with the lower dose of insulin until rebound is ruled in or out.

Natalie

[icaru]

Thanks for all your contributions. I doubt this is rebound as the value is not bounding up quickly as did happen when she was first started on insulin in March. It is drifting up over a period of 8-9 hours, then starts to drift back down.

Yesterday everything was good between 5pm until this morning at breakfast time. Then we gave her the shot and took a BG sample 4 hrs later ... like yesterday we got another reading of 256. I have the feeling that this insulin is not good.

I will try your suggestions of reducing the dose until tomorrow, after which I'll try a new bottle. Unfortunately, the old bottle still had a lot in it but I had used it for 35 days so I threw it out.

I also bought a FreeStyle Lite meter and compared several readings with AccuChek Aviva. They have been almost identical. We find the FreeStyle strips difficult to use, in a very small dog with a very small mouth, it is difficult to get two human hands, one holding the lip and the other trying to see and get that FreeStyle strip at the right angle. Often it doesn't fill. So being that we got many nearly identical readings, we went back to the AccuChek Aviva meter.

The good news is that the cataract that was forming has totally disappeared on a combination of bilberry extract, vitamin E and antioxidant eyedrops. Her eyes are free of all signs of cataracts.

[O'Riley]

Icaru, that is fantastic news about the cataract. Could you please elaborate on your cataract prevention protocol? Names of the products (are all three combined in one drop?), and where to buy, how often you used it, for how long, any other details? Where did you learn about it?

I ran out of strips for my Walmart meter, so this morning I tried once again to use the Freestyle Lite. Those are some strange test strips. I had the same experience as you and couldn't get it right.

~Rose

[icaru]

I read about the use of bilberry extract as an age-old homeopathic cure in two research extracts of experiments done in Italy. Those showed that bilberry extract, taken together with vitamin E, in many case of human cataracts were able to delay or reverse immature cataracts.

I bought the bilberry extract from the VitaminShoppe online, the vitamin E is in the 1/4 vitamin pill that Gigi gets morning and evening. I give her 0.5 ml of bilberry extract after each meal.

The antioxidant eye drops, however, were prescribed in Spain by a Spanish veterinarian and mine are not sold in the US. However, you might find something similar. On the box it says 'N-acetil carnosine'.

Here is a page from a US site that seems to sell the same product:
http://www.wisechoicemedicine.net/store/information.php?info_id=11

Gigi's cataract disappeared after about 2 months of using these products.

[jesse girl]

I have run into a similar problem with my 6 year old beagle who was diagnosed on easter big drops and big rises I fist thought it was rebound and no matter what i did lower the dose or raise it I would still have the same problem of course the lower dose made that early drop less severe Then i started trying to figure out when her food was starting to create blood sugar and it turns out it was 3.5 hours after she had eaten so you can see what happened the insulin started at 1.5 hours after she was injected and she was fed and given a shot at about the same time. She is fed 3/4 cup of wilderness blue buffalo and 1/4 lean beef heart with green leafy vegetables twice a day So I am now giving her 5 units 1.5 hours after her meal and the results are a vast improvement . The only problem is she is a mountain I dont know if it is from this routine or thats the way it is but she drops off towards the end of the cycle which makes it a little difficult to exercise her after her meal because there seems to be some influence of the insulin and no food interaction at the time i take her and she can drop off pretty quick giving her some straight carbs might help but it seems to take a couple hours for that to get into her system so i been giving her a little honey before we go and that will bounce her up but not as much as corn syrup but still working on it . This forum has been a big help for me I wish I found your post earlier as your dog seems to follow the same pattern as mine I treated her situation as rebound and the insulin wasnt working with the food properly as you can see .thanks everyone for your contribution and service for helping the owners and there dogs home testing is imperative it has saved my girl and kept her out of trouble she is a dogie pin cushion but it must be done and on a regulate bases if you are going to be successful.

[O'Riley]

Jesse....how did you figure out that the food was hitting your dog's system at 3.5 hours. In order to find this out, do you withhold insulin completely, then do blood glucose readings at close intervals after meals?

I've read Natalie's excellent article about balancing insulin and food:

http://www.k9diabetes.com/insulinfood.html

I'm just not comprehending how, in actual practice, it is determined that the insulin is getting ahead of food, or vice versa, and further, once you do know, how do you match an NPH insulin, which I've always assumed doesn't hit the system right away?

Icaru...thank you very much for the details re: the cataract drops. Can you think of any reason not to use them as a preventative?

[icaru]

Within the first 3 weeks of starting insulin injections we also found that Gigi was metabolizing the insulin far faster than the food. This was back at the end of March. So we began giving the injection 30 - 45 minutes after each meal and that worked very well until this new situation which seems to have started when I opened a new bottle of insulin on June 27.

Tonight I took a blood sample 30 minutes after her dinner and it was 70. So I gave her some bits of carrot and waited another half hour. At 1 hour after dinner and carrot pieces Gigi's BG was up to 200 ! So the best time for the injection would have been at 30-35 minutes.

I have reduced the dose by 1/2 unit as others here have suggested. Her BG values are not as high or low now but the pattern is the same -- much broader swings than I was seeing before opening this new bottle of insulin. It seems as though it is insulin 'lente' which is not even on the market anymore.

She is on Humulin NPH. Used to be that the low point was after about 4 hrs. Now suddenly it seems to be after 12 hours, i.e., the entire night.

[icaru]

"Matching the insulin" is probably not exactly the case but we quickly realized that Gigi was metabolizing the insulin before the food because in the first 3 weeks of starting on insulin, when the shot was being given just after she finished eating, she had many very rapid episodes of hypoglycemia.

Both we and the vet realized after about 4-5 days what was happening. When we began waiting 1/2 hour after each meal, everything started going much better with fewer extreme swings and no more hypo episodes.

[jesse girl]

Jesse....how did you figure out that the food was hitting your dog's system at 3.5 hours. In order to find this out, do you withhold insulin completely, then do blood glucose readings at close intervals after meals?

I've read Natalie's excellent article about balancing insulin and food:

http://www.k9diabetes.com/insulinfood.html

I'm just not comprehending how, in actual practice, it is determined that the insulin is getting ahead of food, or vice versa, and further, once you do know, how do you match an NPH insulin, which I've always assumed doesn't hit the system right away?

Icaru...thank you very much for the details re: the cataract drops. Can you think of any reason not to use them as a preventative?

First thing i did was figure when the insulin started working I would test every half hour then every 15 minutes It was easy with her she dropped very quickly and the spike down gave me a good starting point . then I went a couple months and tried changing her food time before the shot it did not work originally because the insulin wasnt close enough to make a difference and the time wasnt close and I had that fear of those drops so reluctant to raise dosage . so I backed off and continued going back to giving it with the food for a period of time I did use r to bring her back to normal range but this can be very dangerous . 1/2 unit of r can drop her 200 points so she had to be pretty high so lots of testing for that but this was not sustainable so I made a concerted effort to find out when the food was getting into her system actually that wasn't very difficult to figured out after I decided this was not rebounding i started looking at when she was spiking up then narrow it down by testing around those times some times every 15 minutes when i was close and that gave me the numbers i needed insulin time and food time wright now ime about a half hour start on insulin before food start kicking in big time.

[jesse girl]

Within the first 3 weeks of starting insulin injections we also found that Gigi was metabolizing the insulin far faster than the food. This was back at the end of March. So we began giving the injection 30 - 45 minutes after each meal and that worked very well until this new situation which seems to have started when I opened a new bottle of insulin on June 27.

Tonight I took a blood sample 30 minutes after her dinner and it was 70. So I gave her some bits of carrot and waited another half hour. At 1 hour after dinner and carrot pieces Gigi's BG was up to 200 ! So the best time for the injection would have been at 30-35 minutes.

I have reduced the dose by 1/2 unit as others here have suggested. Her BG values are not as high or low now but the pattern is the same -- much broader swings than I was seeing before opening this new bottle of insulin. It seems as though it is insulin 'lente' which is not even on the market anymore.

She is on Humulin NPH. Used to be that the low point was after about 4 hrs. Now suddenly it seems to be after 12 hours, i.e., the entire night.

I am getting the same result a pretty good drop the last 3 hours about 50 point or more before meal It would be nice to slow that drop or stabilize it I guess I could give her some kind of snack but her system takes awhile to produce sugar maybe try some honey it seems to work slower than corn sryup and not as drastic a rise .

[jesse girl]

"Matching the insulin" is probably not exactly the case but we quickly realized that Gigi was metabolizing the insulin before the food because in the first 3 weeks of starting on insulin, when the shot was being given just after she finished eating, she had many very rapid episodes of hypoglycemia.

Both we and the vet realized after about 4-5 days what was happening. When we began waiting 1/2 hour after each meal, everything started going much better with fewer extreme swings and no more hypo episodes.

Your vet seems to have a good handle of the situation and working well with you.

[O'Riley]

This is all very, very interesting. I'm going to have to print out these last few posts and study them. I'm hopeful that a light will switch on in my brain and all of this will sink in. Natalie wrote in her article about Chris that too much time might be lost looking for Somogyi where it doesn't exist (or words to that effect). I guess the main question I still have is, Jessie....you said, "once you figured out it wasn't Somogyi"....and I'm sorry to be so hardheaded, but how did it NOT being Somoygi become apparent to you?

[k9diabetes]

Sort of the core idea is that any time the blood sugar is dropping, there is more insulin working than there is glucose available. Any time the blood sugar is rising, there is more glucose getting into the bloodstream (from food) than there is insulin available to do anything with it.

So if the blood sugar is 200 at meal time, you watch what it does in the next couple of hours.

If the BG drops, then the insulin (sometimes because some effect is left over from the last injection) is getting into the bloodstream before there is enough food to go with it. Only a problem if the drop is sharp. A gentle drop is okay.

If the BG goes up, then the food is being digested quickly and immediately converted to glucose while the insulin still hasn't gotten up a head of steam to match it.

It can be a complex interaction - starting glucose level, whether it was already rising or falling at meal time, any leftover effect of the last insulin injection, how fast the food is digested, how fast the insulin is absorbed.

People have sometimes experimented with giving a small amount of insulin and no food so they could see the action of the insulin all by itself.

You have to know what you're doing to do it and be able to test often. It does give you a sense of how the insulin is absorbed and put to work from the injection. This would be especially useful if there was a question about whether the insulin absorption is being delayed so having an affect after 12 hours.

But... how much glucose goes with the insulin also affects how long it lasts. So there's ultimately no separating things out entirely.

So you work with curves done over multiple days to identify points where there are sharp drops or sharp rises in blood sugar and you adjust meals and injections to try to flatten out the peaks and valleys.

Most likely the dropping blood sugar at the evening meal is a result of giving the insulin late. It is still having an effect then at dinner time.

Hope that makes some sense.

Natalie

[jesse girl]

This is all very, very interesting. I'm going to have to print out these last few posts and study them. I'm hopeful that a light will switch on in my brain and all of this will sink in. Natalie wrote in her article about Chris that too much time might be lost looking for Somogyi where it doesn't exist (or words to that effect). I guess the main question I still have is, Jessie....you said, "once you figured out it wasn't Somogyi"....and I'm sorry to be so hardheaded, but how did it NOT being Somoygi become apparent to you?

Yes I missed that one by Natalie I sure wish I read it but did not see it I spent months thinking this was rebound and trying to control it by dropping the dose for awhile then raising it changing food and how much i would feed her ect. I would have never thought it was taking this long for her food to turn into sugar What I did was look at the steep incline after the big drop and figure when that happens test closely around that time to get as close as i can to when this happened and if you know when your insulin is taking effect bring the two together I have been giving her insulin shot so that it will take effect a half hour before the sugar is getting into her system hot and heavy. it is coming down to tenths of a unit now I was going half units say i would go to 4.5 units and when the food interacted with the insulin it when up from 180 to 250 and stay there until start backing down the last 4 hours which is great from the 300 and 400 so lets see if we can do better and go to 5 units I would get a slow drop from 200 to 100 for the hole day but those last 4 hours she would drop further and get to low for me. so now i am getting into smaller increments I need the big magnifying glass to do this its hard to believe that these small amounts make this much difference.

[jesse girl]

Sort of the core idea is that any time the blood sugar is dropping, there is more insulin working than there is glucose available. Any time the blood sugar is rising, there is more glucose getting into the bloodstream (from food) than there is insulin available to do anything with it.

So if the blood sugar is 200 at meal time, you watch what it does in the next couple of hours.

If the BG drops, then the insulin (sometimes because some effect is left over from the last injection) is getting into the bloodstream before there is enough food to go with it. Only a problem if the drop is sharp. A gentle drop is okay.

If the BG goes up, then the food is being digested quickly and immediately converted to glucose while the insulin still hasn't gotten up a head of steam to match it.

It can be a complex interaction - starting glucose level, whether it was already rising or falling at meal time, any leftover effect of the last insulin injection, how fast the food is digested, how fast the insulin is absorbed.

People have sometimes experimented with giving a small amount of insulin and no food so they could see the action of the insulin all by itself.

You have to know what you're doing to do it and be able to test often. It does give you a sense of how the insulin is absorbed and put to work from the injection. This would be especially useful if there was a question about whether the insulin absorption is being delayed so having an affect after 12 hours.

But... how much glucose goes with the insulin also affects how long it lasts. So there's ultimately no separating things out entirely.

So you work with curves done over multiple days to identify points where there are sharp drops or sharp rises in blood sugar and you adjust meals and injections to try to flatten out the peaks and valleys.

Most likely the dropping blood sugar at the evening meal is a result of giving the insulin late. It is still having an effect then at dinner time.

Hope that makes some sense.

Natalie

very well said so by giving the meal 1.5 hours before the shot the food is not producing any sugar those last few hours but the insulin is still affecting whats left of the blood sugar . her sugar levels are flat after mealtime except for her walk which could lower her further I have noticed if there is any insulin left she will drop further during exercise if there isnt she may even rise after exercise . I have been using some honey before her walk to boost her up carbs dont help it just takes to long . if you have any suggestions natalie it would be very appreciated.

[icaru]

WHERE you inject the insulin also makes a big difference, I have found. If you inject it near a large muscle mass (hind or forelegs, for example) or anywhere where there is a nearby and abundant supply of blood vessels, the insulin is absorbed much faster.

In this period of ups and downs after opening a new bottle of insulin, at one point Gigi's BG went to 378 after a meal. To bring it down quickly I gave the injection in the loose fold of skin near her foreleg elbow. Within 30 minutes her BG was down to 156. If I inject anywhere along the spine or back of the neck, this doesn't happen.

Conclusion: every dog is different, only a little experimentation and a lot of checking will tell you about how your dog uses the food and insulin.

I also read yesterday that doctors are now saying BG charts are non-reproducible and as such, not very useful. They may not be predictable or perfectly reproducible, but they can tell you a lot about your dog and this is important.