Still need help with Bailey

[waynorth]

Hi, I'm new here :) My Maltese, Bailey, has been diabetic for a year now after suffering from GME Encephalitis, which he kicked with a year of chemo and prednisone. The pred destroyed his pancreas. He was doing great on 7 units of Vetsulin twice a day, but in the past two months everything has gone haywire with his numbers. I know there is a recall on Vetsulin and I told my vet (who didn't know about the recall) and he said the problems were with previous batches, not the batches in recent months. I use an AccuCheck meter which has been tested with control solutions and it's working fine. I took Bailey in for a CBC and fulll panel profile and he's perfectly healthy, so the problem isn't there. In the past two months he has lost vision in his left eye and I'm desperate to save the vision he has left in the right eye. I test him often and here's an example:
400 before feeding in the morning (he can't stay down in the 200 range anymore 12 hours after his last shot) I feed him and give the shot and yesterday his seven units plummeted him to 34 within an hour of giving it!! I was rubbing Karo on his gums to bring him back up. Today he was 380 before his morning shot, fed him and gave the shot and an hour later he was 106. This afternoon when I get home he could well be 400 or more or some days he's at 138. His numbers suddenly are just all over the place and I don't know why as nothing has changed with his food.

I'm about to demand to be switched to another insulin, but what problems then will that bring on?

Does anyone have any advice or think it could indeed by the Vetsulin?

Thanks in advance!
Worried Mom!

[peggy0]

Hi Baileys Mom. The vetsulin supply is gone with the exception of those who cannot be regulated on another insulin, so your vet is not informed and that is a worry to begin with. I'm assuming that you monitor at home given the numbers you have provided. Have you done a curve recently to see what Baileys numbers are over a 12 hour period? One of the vetsulin problems is that there are more long acting crystals and the hour after feeding could be an overlap situation with the insulin you gave at dinner time and the new insulin shot at breakfast.That would be my first thought. When my dog went low like that, he stayed higher for days. Their bodies release hormones to protect them against the low. I would definately tell your vet you want to switch to NPH or Humulin N. NPH is Walmarts generic version of Humulin and many dogs here have done great on it. My dog did not and I had to use Humulin N. He was regulated in 3 weeks and his BG was better than it ever had been on Vetsulin. There are many articles on the board here about Vetsulin explaining the issue. If the vet doesn't beleive it, tell him to go out to their web site. www.vetsulin.com. There is advise for vets and for dog moms :). You will need a U100 syringe vs. the U40 you use with Vetsulin. This is very very important. Most folks here cut the dosage they are current giving by 25% just to be safe, so you would begin with 5.25 twice a day. The dosage on NPH usually ends up being the same as Vetsulin. Welcome to the board, and we are here to help you get Bailey back to normal. Ask as many questions as you need to!!

[eileen]

The Vetsulin supply is very limited and being reserved for critical care cases. Intervet (the manufacturer of Vetsulin) has been telling veterinarians for months to switch their clients to another insulin...namely NPH.

http://vetsulin.com/vet/Vet_ProductAlert.aspx

You can use either Humulin N made by Eli Lilly or Novolin N made by Novo Nordisk. They are both NPH insulins.

Walmart's ReliOn Novolin N is NOT a generic NPH. It is made by Novo Nordisk and labeled ReliOn to be sold by Walmart or Sams Club at the discounted price. It is the SAME as other Novolin N that is sold in other pharmacies.

http://www.relion.com/information/faq-insulin.htm

There are NO generic NPH insulins. Just different manufacturers.

http://diabetes.emedtv.com/insulin/generic-insulin.html

My dog has been on NPH (Walmart's ReliOn Novolin N) insulin for almost 6 years now and has done wonderfully.

[waynorth]

I am off tomorrow, so I'm planning to do a 12 hour curve myself with my meter. I talked to my vet today and he said since Bailey is so low one hour after his shot to drop the seven units to five, but I said that doesn't make sense if he's testing over 400 8 hours after the shot and even seven isn't sustaining him at a safe level for apparently very long.

With the twelve hour curve, would I start before his shot, record that, feed him and give the shot, and then begin testing at each hour?

Thanks for all the help! The year we battled GME encephalitis was long and expensive. I absolutely refuse to have something happen to him now!

Jackie

[Patty]

I talked to my vet today and he said since Bailey is so low one hour after his shot to drop the seven units to five, but I said that doesn't make sense if he's testing over 400 8 hours after the shot and even seven isn't sustaining him at a safe level for apparently very long.

With the twelve hour curve, would I start before his shot, record that, feed him and give the shot, and then begin testing at each hour?

Jackie,
Yes, you would start with a fasting reading that's before food/insulin. Then if he's dropping so low one hour after his shot, if it was me I would test more frequently around this time period. Maybe at:
Fasting
30 minutes
1 hour
1 hour 30 minutes
2 hours
4 hours
6 hours
8 hours
10 hours
12 hours - fasting before food/insulin
30 minutes
1 hour
1 hour 30 minutes

You might be able to catch exactly what's happening that way.

However, it sounds like you already know he's in a pattern of dropping that far...
I test him often and here's an example:
400 before feeding in the morning (he can't stay down in the 200 range anymore 12 hours after his last shot) I feed him and give the shot and yesterday his seven units plummeted him to 34 within an hour of giving it!! I was rubbing Karo on his gums to bring him back up. Today he was 380 before his morning shot, fed him and gave the shot and an hour later he was 106.
I would tend to agree with your vet on this one as far as reducing the dose so there are no rapid drops to see if rebound is actually the issue. If the hormones are kicking in creating the highs as Peggy described, reducing insulin should be the answer.

But, because Vetsulin is no longer available and what's on the market is rapidly running out, I would seriously consider switching to NPH insulin.

Hope that helps,
Patty

[CraigM]

Doesn't 7iu X twice per day sound high for such a small dog? Maltese are usually between 4 - 7 pounds?

Also, I THOUGHT insulin normally takes an hour, or longer, to kick in.

I'll be reading this thread and wishing you luck.

Craig & Annie

[waynorth]

Bailey is ten pounds and I was told that because his pancreas is almost nonfunctional now after the high pred dosing for a year and his immune system doesn't function properly (the encephalitis was an autoimmune disorder) that he may need more than the average ten pound dog?

Once I do this curve, would it be ok if I post the results here to see what people think?

Thanks,
Jackie

[Patty]

Once I do this curve, would it be ok if I post the results here to see what people think?

Absolutely :)

[CarolW]

Jackie - a very huge welcome to you; I deeply trust you'll find this forum helpful. Of all the forums on canine diabetes I've been on, this one is by far the most accurate and useful (in my opinion, of course!)

Now, about Bailey - I thought Peggy and Patty and Eileen all gave you great info, and I have nothing in particular to add to what they said. Except maybe for one thing. If Bailey were my dog, I believe I'd make the change of insulin right now!

Don't know if you need a script from your vet - probably not for insulin, depending where you buy it, but you might need it for the U-100 syringes.

Dear Bailey - what a brave boy! And, what a FABULOUS Dog-Parent you are! Keep up the great work!

Forgot to say - yes, by ALL MEANS, please post his numbers! Have a look around the forum, and you'll see most of us do that! I'm curving Kumbi today, and getting STRANGE numbers!

Mon, 10 May 2010 15:27:09 (PDT)

[waynorth]

I'm going to start the curve tomorrow morning, but this afternoon I had to come home from work and leave quick to make an appt. and I didn't want to not be here in case he dropped too low again with me gone. I tested him before the shot and food, which was twelve hours since his last one and he was at 420. My vet said lower him to five units from seven. I only gave him three knowing I would be gone. I tested him two hours later when I got home and he'd already dropped to 62 in just two hours. We have just never had this problem before. I think it has to be the insulin and I'm calling tomorrow to be switched even though I plan on doing the curve. That might give me more ammunition to present to my vet who is being very stubborn about this for some reason. I live in a very small town and there is not another one to go to for a second opinion.

I just started reading about the "rebound" which I knew nothing about and I don't know if it applies to him or not because we aren't increasing insulin, we're decreasing.

Thanks so much for the info. No problems solved yet, but I feel better already. I love this little guy so much and he fought a brave battle with the encephalitis - three kinds of chemo, MRI's, high pred to bring down his brain inflammation for a whole year. When that hit so fast, he was spinning like a top (circling) and couldn't stop, went completely blind (his vision came back) and didn't know his foot from the foodbowl. The vet here gave him a week, but I found a Dr. in Boston who has pioneered new research into this disease and he was Bailey's miracle.

I will post the curve results tomorrow. Thanks again everyone!
Jackie

[CarolW]

Jackie,

I look forward to your next report.

Special hugs to you and Bailey.

Mon, 10 May 2010 15:58:07

[k9diabetes]

Hi Jackie,

Please do move forward with switching to NPH. You can show the letters by Intervet, which are nearly begging vets to make the switch as they know supplies will run out to the vet. Especially point out the later ones in February or March where they make it really clear that vets need to be switching over.

You can download them here: http://vetsulin.com/vet/Vet_ProductAlert.aspx

At the bottom of the page are links to PDF copies.

NPH is a wonderful insulin for dogs and nearly all of the dogs here who have switched have been completely successful. So far, we have just one dog who can't use NPH and will need the Critical Supply program. There are some vets who have just never used it. But they undoubtedly used Humulin L in the past, which was human insulin too.

As far as Bailey's blood sugar...

It could be that Bailey has been rebounding for several months now because, for whatever reason, he needed less insulin than he was getting. And that rebound is the cause of his crazy blood sugar.

The really confusing part is that rebound can throw the blood sugar off for as much as 3 days after it occurs.
The best way to make sure rebound isn't involved is to cut the insulin as the vet has asked you to do, let things settle for at least three days and then do a full curve to see what the food/insulin balance is then like.

So your curve tomorrow could show high blood sugar that is partly a remnant of the last rebound. If the blood sugar is all high, I wouldn't assume that 5 units of insulin is not enough. I would want to see readings three to five days after the reduction.

The other thing I wondered about is the eye - is it definitely just a diabetes induced cataract?

The cataract itself tends to be inflammatory and that could be changing Bailey's insulin requirements and pattern. Or there could be something more serious going on since typically diabetes induced cataracts occur in both eyes more or less simultaneously.

The cataracts should be treated to control inflammation with eye drops, preferably nonsteroidal ones as the steroid versions can raise a dog's blood sugar even though there's limited contact with the bloodstream.

Do they feel his pancreas is still able to generate digestive enzymes?

Natalie

[k9diabetes]

I just want to make sure I understood you - you gave only 3 units of insulin and Bailey's blood sugar fell to 62?

When did he go off of the prednisone?

If I understand it properly, then his insulin dose would need to be even less than 3 units to avoid rebound.

But I may be confused! :)

Natalie

[waynorth]

He went off prednisone four months ago. The neurologist in Boston is the one who determined the cataract is diabetes related. It's just been in the past two months that it's gotten bad and that's when Bailey's numbers began to fluctuate. A high white count is an indicator in him that the GME (encephalitis) has returned and his CBC the other day showed a normal count. That is always a concern.

His lipase level is always high. He was hospitalized for ten days with acute pancreatitis after a high pred dose needed to bring his brain inflammation down during a relapse he suffered while on chemo. Right after that he began needing insulin.

I did his first fasting test at 3:00 AM and it was 514. I knew it would be high after only the three units I gave yesterday, but it has been that high before on seven units.

Thanks for the info on rebounding. I'm going to read more about that today.

Jackie

[waynorth]

Now I'm not sure what to do. We began the fast test at 3:15 and he tested at 514. I gave him five units and fed him. At 4:15 he had dropped to 247. Just now at 5:15 he tested at 87. I may do it again in half an hour because I don't want it to drop any lower. If it does and I have to give Karo again, that will mess up the curve for the rest of the day won't it?

Thanks,
Jackie

[BestBuddy]

Hi,
Giving Karo or extra food will change the curve but it really looks like that is going to be what is needed.
Those BG numbers could keep dropping for quite a few more hours yet so I think you are going to have to give the Karo and some food to keep the BG from dropping too low. I wouldn't worry about the curve but it will be important to keep a check to see how low he gets.
Jenny

[waynorth]

You were right. I tested again and it was 54 so I gave him some Karo. How much should you use and how quick should you test again after that?

Thanks,
Jackie

[Patty]

Hi Jackie,
I'm glad you gave the karo. You'll want to follow up with some food as well. I'd test at 15 min and 30 min to be sure he's not continuing to drop.
Patty

[Patty]

The syrup should get into the system quickly and the food will keep the blood sugar from dropping later once the syrup is gone. I would keep a close eye and test periodically to be sure.

Jackie, with rebound or somogyi effect when the blood sugar drops more than 100 points in an hour or gets too low the body kicks in with counter regulatory hormones to protect itself. The liver stores glucose for times like this. When a drop as quick as you are getting occurs, the liver may be releasing the stored glucose into the bloodstream to save the body.

So the rise you see after this sharp drop is suspicious of this glucose release I described. Once the glucose is in the blood stream you see the sharp rise in blood sugar. http://www.caninediabetes.org/pdorg/somogyi.htm

The solution is typically to reduce insulin so you no longer have this sharp drop and have the hormones kick in. But it usually takes a few days for the body to restabilize as Natalie indicated before: The really confusing part is that rebound can throw the blood sugar off for as much as 3 days after it occurs. The best way to make sure rebound isn't involved is to cut the insulin as the vet has asked you to do, let things settle for at least three days and then do a full curve to see what the food/insulin balance is then like.

If 3 units still caused such a steep drop, I'd try 2 units.

I would also look into NPH as I think it would be a benefit for Bailey.

Patty

[waynorth]

Even after Karo syrup and food he isn't climbing fast. I just gave him some more food. So far, this is his day.

Fasting test 3:00 AM 514
FEED/SHOT 3:15 AM 6 UNITS
TEST 4:15 AM 247
TEST 5:15 AM 87
TEST 6:15 AM 86
TEST 7:15 AM 54
GAVE KARO SYRUP and CHICKEN
TEST 8:00 AM 64
TEST 8:30 AM 72

[Patty]

I would add something with a bit more carb to it. Daisy uses bread with Noodle and Linda used this last night with Ladybug.

I can't remember what Bailey is eating, but did you add some of his food or just the chicken?

Patty

[waynorth]

I cooked a frozen spaghetti dinner and gave him a few noodles. Guess I'll have spaghetti for breakfast :) I'll test him again in about fifteen minutes.

Thanks,
Jackie

[Joan]

Patty is absolutely correct in that white bread is one of the fastest foods to correct low bg, glycemic index of white bread is 100, pasta is relatively low glycemic esp whole wheat pasta is 39.

BTW I had this exact same trouble with the Vetsulin/Caninsulin, and could not resolve it until I changed to Humulin NPH.

[waynorth]

After Karo, chicken, noodles, and a little more Karo he's up to 87. Should I give him more food? I have no white bread, but will go get some to have on hand. Baily thinks he's in heaven this morning having food offered to him so many times!

Joan, when you switched the insulin did you have to do a curve on that the first day or just lower the dosage 25 percent less like I've heard? Luckily I am home today and tomorrow, but like everyone else, you can't test your dog every hour on a work day. So is that something I'll need to plan for when making the switch?

Thanks,
Jackie

[Joan]

There are a lot more experienced people here to answer that question, but I did start at 25% less insulin, and I tested often the first few days, but it takes the dogs a few days to settle in to a dose before a curve is very informative.

My dog was actually rebounding from that quick drop you are getting as well right after the insulin, she never got too low, but at that time I did not know they could rebound before they ever got low. She did the same as your dog., she could drop up to 300 pts in an hour. That triggered the liver to release glucogen as a defence, and up she would go.

The good news is, that within days of the the change to Humulin, it was so much better. Still took a lot of tweaking to get her where I wanted her, but all those dramatic highs and lows ceased within a day or two.

[eileen]

Jackie,

If you have any cereal around you can try giving him some of that so to try and increase the bgs a bit more.

[waynorth]

Thanks for the advice. Since he loves Wheat Chex, I see a smile on his face pretty quick here!

[Patty]

Hi Joan. Good to see you over here :)

How's Bailey doing Jackie?

[waynorth]

Seven and a half hours after his shot and he's finally up to 100 after a ton of food and Karo Syrup. I called my vet and told him I want to pick up the other insulin TODAY. He doesn't have the different syringes so he had to call around to see if I could get them anywhere here. I haven't heard back from him yet,. but being home tomorrow also it's a perfect time to make the switch so I will be here to monitor him. There is no reason to go through another day like this or the past month we've had. I use a 29 guage needle with Bailey and I hope that can stay the same as anything larger really hurts him.

Thanks,
Jackie

[eileen]

Jackie,

You can purchase Humulin N or Novolin N at any local pharmacy as well as the required U100 syringes.

My recommendation would be to ask to start with Walmart's ReliOn Novolin N (about 25.00 a vial).

Walmart also has ReliOn U100 syringes at 12.58 for a box of 100. A very good choice for many of our dogs is the 0.3cc (measures up to 30u), 5/16ths short needle, 30 or 31 gauge which is very easy on the dog (keep in mind, the higher the number of the gauge the thinner the needle). These syringes come with half unit markings which is very helpful when dosing in fractions.

Good luck!!!
I think you are making a very wise decision.

[Patty]

Jackie,
If your vet will write you a prescription (some states need one and others don't) you can get the syringes and insulin at just about any drug store including Wal-Mart.

You want to make sure they are U100. I prefer the 3/10cc, 5/16" length, 31 Gauge with 1/2 unit markings. The 1/2 unit markings are so helpful in fine tuning small doses. The needles are shorter in length and smaller in size (gauge) than what you are currently using.

Many people use Walmart's Relion Novolin N because it's cheaper. Around $20 some dollars. Or Humulin N which is usually around the upper $40s. They are both NPH insulins just made by different companies.

Hope that helps sort things out some.
Patty

[waynorth]

Me and the boys (Bailey and Alvin, his brother ) are heading out the door now to Walmart and he will get it for his afternoon shot. Enough of this nonsense! Thanks for the syringe info. I printed it out and am taking it with me.

My vet said start him at four units compared to seven he used to get. I know that's more than the 25 percent drop, but I'm thinking he was planning to drop the Vetsulin with the way things have been going.

So if Bailey were taking six units of Vetsulin, starting at four of the other - is this a safe beginning?

Thanks,
Jackie

[eileen]

Jackie,

Be sure to have the necessary scripts or you may hit a road block.
I live in California where a script is not required to purchase syringes yet the local Walmart pharmacy does require one.
You may want to call ahead to check.

Also be VERY sure that the insulin you are handed is ReliOn Novolin N...NOT Novolin R as I know of a case where R was given accidentally.

Just check the label before walking away from the counter.

[Patty]

Jackie,
You are getting a significant drop on 6 units and even got quite a drop on 3 units before.

Just in case this is not the Vetsulin causing this, but perhaps Bailey's need for insulin is changing in relationship to the pred ending, I'd start at 2 units of NPH to be safe.

Patty

[CraigM]

Jackie,
I think you are going to be really happy in the near future! The switch to WalMart's ReliOn Novolin N was the best thing for Annie. If you don't have a WalMart, or Sam's Club, handy and go with another brand on NPH (N) that will be alright, just a little more expensive. Our nearest WalMart is 20 miles away, but worth the trip since I buy three vials, plus syringes, every four months.

It's better to start a little low and work up, so starting at 2 or 3 units is probably smart. Then make small increases after about four days.

Good luck.

Craig & Annie

[waynorth]

It's a one way forty mile trip for me, but the guys enjoyed the ride today. I just checked him and he's up to 345 so I'll go with three units of the new insulin and see what happens the rest of the day. This needle on these new syringes is so small compared to the one I was using!

Now if at say nine tonight he's getting high and isn't due for a shot until three in the morning, would I give him more and some more food at that point? I just want to ask now in case no one is around later. I get more info here than asking my vet, so thank you all so much.

Jackie

[CraigM]

Jackie,
My thought would be to feed and inject the three units for a couple of days. No between meal snacks, unless Bailey goes low; and stay with the three units for a few days. Same amount of food 12 hours apart. Try to be consistent and not chase the numbers.

Bailey is going to love those new syringes!

Craig & Annie

[eileen]

Jackie,

You only feed and give insulin every 12 hours. If as Craig states he shows signs of going low you would want to snack.

You do NOT give any 'extra' insulin injections in between these 12 hours.

[waynorth]

With this new insulin and starting at a very low dose, I wouldn't give him a small dose if he were well in the 500's with hours to go until his next shot? My vet had me do that recently so I assumed that was an ok thing to do instead of leaving them high for hours. I never give insulin if his reading is low. Maybe I worded that wrong, sorry!

[eileen]

NO, you do NOT want to give him any additional insulin even if he shows to be high and it is not at his scheduled meal and injection time...which is every 12 hours.

Doing so will in most cases cause insulin overlap resulting in hypos, rebounding and never really reaching any sort of regulation.

With careful feeding and scheduled insulin injections you will be charting his numbers so to figure out when and if his set dose needs to be raised so to stop these in between highs.

[waynorth]

Wow, was I misinformed by my own vet. He's diabetic and used himself as an example that if he eats something he shouldn't he will give himself a little insulin to bring his numbers down. I just assumed that applied to animals as well. I only did that once last week, so it's probably not what is causing this I wouldn't think.

Bailey got his shot at 3:00 and so far, he isn't down from the 353 he was at before it. This new syringe needle is so small and the amt. at 3 units is so little, now I'm hoping I didn't screw it up. The needle is so short compared to what I was using I hope I actually got it in him. I'd feel more comfortable if I could use his previous syringe, but that won't work, will it? I know the 3 units on the new one would be different on his old one. I put red food coloring in water and drew it up into the new syringe at 3 units and then squirted that into a cup and then pulled it up into his old syringe to see where it went, but the amount is so small it's difficult to pull it into the syringe.

I'm going to test him again soon and see if there's a change :(

I've already learned in a day that low numbers don't automatically mean Karo syrup, but should be treats unless the dog is displaying signs of hypoglycemia. Bailey never has even when it got down to 36 once. I didn't know there was a difference in how the body later handled the sugar in Karo and the sugar/carbs in treats. What a wealth of information is available at this site!

Jackie

[eileen]

Jackie,

Human diabetics use what is called, bolus insulin, this is either Regular, Humalog or Novolog to cover their carb intake. These insulins are referred to as fast and rapid acting. It means they act quickly, keep the body from going too high due to whatever was ingested and are then gone from the system in a few hours.

What most of us use with our dogs is a basal insulin, this is what the Novolin N is that you are now using. It is an intermediate insulin that is designed to work gradually and over a span of many hours. This is why we inject it every 12 hours as most often this is the duration of the NPH.

Injecting it any more than at 12 hours and it will overlap with the previous injection as well as the injection to come.

You can't expect immediate results from this new insulin, it takes time. Most often at least 6 injections or 3 full days to begin to see the effects it is having. You must have patience.

Please do NOT try and use your old U40 insulin syringes with this U100 Novolin N.
With such small dosing you must be extremely careful as every minute fraction can make a tremendous difference. There is no room for any error which can easily be made by trying to fanagle the old syringes to work with the new insulin.
Again, be patient, you WILL get use to them.
Your doggie is most likely loving the new syringe as it is so much more comfortable for him.

[CraigM]

Jackie,
One thing you can do for the new short syringes is to give Bailey a little haircut around the area you inject, if that is your concern. I have a small battery powered trimmer that I run over Annie's injection site, and test area, every few weeks. She just got her Summer grooming (short) yesterday, so she will be good for a while.

Food, then injection, 12 hours apart. Really try not to give any snacks during this time. I know its our nature to try to correct the problem (high numbers) when we see them, but take it easy. Yes, you may see numbers in the 400s and higher for a few days, but they WILL COME DOWN.

One other thing you might consider is a food scale to be as consistent in your feeding as possible. I feed Annie 2.7 ounces of her dry food. I'm sure I would get close using measuring cups, but not as accurate as using the scale.


Craig & Annie

[eileen]

I agree with Craig on the importance of a food scale.

The volume in a measuring cup can move around. When weighing it is always spot on.

Rotating injection sites is important as over a period of time scar tissue can build up which will affect the absorption of the insulin.

[waynorth]

He's now dropped from 353 to 154 so I'm not worried I didn't give the shot. I have a moser and do my own grooming, so I can shave his neck closer tonight and be able to see what I'm doing. When Bailey was on chemo last year he couldn't go to the groomer for fear of catching something, so I had to learn to groom him. Now, it's fun!

No snacks tonight. It'll be tough, but we'll do it even though he'll latch on to my pant leg hem and drag around half the night.... LOL. I'm going to test him every hour still to make sure he doesn't drop too low.

Thanks for all the advice.
Jackie

[eileen]

Yes, do watch carefully so that he does not drop too low.
Don't be hesitant to snack if he does.

In what time frame did he drop from 353 down to 154?

You say you're injecting into the 'neck', I assume you mean the scruff?

Here is a diagram with desireable injection sites on a dog.

http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7395

[waynorth]

Yes, I inject in the scruff area. He ate and then got his shot at 230. Then he was at 354. At 4:30 he was still at 353. He dropped to 154 at 6:00, so 3.5 hours after his shot. Is this going too fast?

Thanks,
Jackie

[eileen]

Ok, be sure that you rotate around the scruff area or else over time it can cause hardened areas that will interfere with the absorption rate of the insulin.
This I know from personal experience as I did not and now Mildred has lumps in her shoulders.

The drop from 353 to 154 happened in 1 1/2 hours. Continue to monitor as sometimes when there is a drop of 100 or more points within an hour it can cause rebound. This shows a drop of 200 points in the hour and a half.
Hopefully this will not be the case which would show with your next reading.

Do continue to watch carefully.

[CraigM]

I'm watching your progress :-)

What are your NORMAL feeding times going to be?

[waynorth]

Our normal is not most people's. I leave for work at 3:00 AM, so Bailey's shot and feeding is always at 2:00 AM, which leaves me some time to watch him before I leave. On my days off, I have to follow the same schedule with him, so it's around 2:00 AM and then 2:00 PM in the afternoons. Believe me, I'd like to sleep "normal" hours on my days off, but you do what you have to do. Besides, if I slept later I'd miss all those wonderful infomercials at that time of night! Right......

Jackie

[waynorth]

Bailey just tested at 100. Here are the results since the new insulin this afternoon:


test 2:00 PM 354
FEED/SHOT NEW INSULIN
2:30 PM 3 UNITS
TEST 4:30 PM 353
TEST 6:00 PM 154
TEST 7:45 PM 100

I hope he doesn't continue to drop.

Jackie

[Patty]

Jackie,
I looked back through your info and don't see what you are feeding.

What is it that Bailey eats and how much?

I know you said his pancreas was quite affected. Does he produce sufficient enzymes for digestion? Or do you add a digestive enzyme?

You may have to feed him to prevent him from going lower. I would also consider cutting back to 2 units for next injection since he has quite a wide range now.

Patty

[eileen]

If it were Mildred dropping like this and now down to 100 I would not wait another 2 hours before testing again.

You might want to test again now to see which direction he is going. If the same or lower you may want to give a small snack.
I would not like to see the bg any lower.

You may also want to cut back on the next insulin dose, say down to 2u.

[waynorth]

I do sprinkle a tsp. of digestive enzyme on his food at each feeding. He needs to lose weight as the prednisone really packed on the pounds so he's eating Hills W/D mixed with chicken breast and cooked veggies. His treats are homemade from a diabetic dog website made with liver, rice flour with no gluten and egg.

I just tested him again and he's risen from 100 to 110.

Jackie

[CraigM]

Excellent!

[eileen]

Jackie,

Taking into consideration the percentage that all meters are off from one reading to the next, 110 is basically the same as the earlier 100.

Be safe and test again very soon to be sure the bgs are actually rising.

[waynorth]

Morning all!

Bailey's pre-shot reading this morning after 3 units of the new insulin yesterday was 525

He never went below the 110 six hours after that shot (or 100 giving some wiggle room with the meter) and was then climbing to 125 an hour after the 110. This morning I gave two units as was suggested yesterday.

Unfortunately, after getting up at 2:00 AM yesterday I fell asleep after the 125 reading so I never got to get any more. I'm assuming he continued to climb since it was so high this morning.

I will continue to do a curve today. I'm sure glad I'm home to do this and don't have to rush out the door for work and then worry all day.

Thanks,
Jackie

[waynorth]

5:30 bailey update

[waynorth]

Sorry, hit the wrong button on that previous post.

Bailey has dropped to 384 since his first preshot reading of 525 this morning before food or his 2 unit shot. The drop was over a 2.5 hour time period.

Already on the new insulin, he doesn't seem to be experiencing the dramatic fast drop he was on Vetsulin just two days ago. But what could be causing the insulin to not hold him bringing him up so high the closer he gets to shot time again? I probably shouldn't assume that will happen on this insulin and give it time to see if it does. Maybe he will level out.

Thanks,
Jackie

[waynorth]

This is so far today from 2:30 this morning on the new insulin. I'm posting a recap so everyone doesn't have to read my previous posts this morning.

Wednesday

TEST 2:30 AM 525
FEED AND SHOT 2 UNITS
TEST 4:00 AM 454
TEST 5:30 AM 384
TEST 7:30 AM 216


He's certainly coming down more slowly than the past days on Vetsulin, but it's a shame the number is so high to come down from. Perhaps the new insulin will get him back to normal over time?

Thanks,
Jackie

[Patty]

Jackie,
I would see what you get over the next couple of days on 2 units. It may take some food "tweaking" to get a good balance. I'd post exactly what he's eating (amounts, time) within your curve so we can help with that after the next few days.
Patty

[waynorth]

Thanks, I will do that. Watching his better numbers today (or slower drop, certainly not good numbers) I won't be so worried leaving for work tomorrow.

Jackie

[Joan]

I am not sure when or how many of your treats you are giving? but the glycemic index of rice flour is 95. That is very high! While it is gluten free, which is good if they are allergic to gluten (celiac), it does not help out the problem of rising bg for diabetics, in fact it is worse than white flour. You might try substituting whole wheat flour, unless your dog has trouble with gluten.

[waynorth]

The recipe said don't use anything with gluten for diabetic dogs because gluten raises blood sugar and rice flour was suggested. I'll have to check further into his treats.

Ok. Now I'm not sure what to do. Below is the twelve hour curve I've done today. He began extemely high and now after 12 hours is getting lower. His shot is due now and I don't have a clue how much to give him. Normally, he's rising up as he gets closer to his shot, not lower. I'm kind of worried that even with feeding him being where he is now at 139 he'll drop too low tonight. He's not had any treats today as I didn't want that to interfere with his readings.

TEST 2:30 AM 525
Feed 1/2 cup cooked chicken (wouldn't eat his W/D)
SHOT 3:00 AM 2 UNITS
TEST 4:15 AM 444
TEST 5:30 AM 384
TEST 7:30 AM 216
TEST 9:00 AM 194 6 Hour Mark
TEST 10:00 AM 182
TEST 12:00 PM 168
TEST 2:20 PM 139


I'm going to wait on his shot and hope someone replies.
Thanks,
Jackie

[waynorth]

Bailey's shot is overdue now and I'm not sure what to do. My vet says that since he was at 138 twelve hours after his shot that I should just give one unit of insulin. Bailey ate and he's up to 234 now. Does one unit sound ok?

Thanks,
Jackie

[CarolW]

Hi Jackie,

It's very hard to answer your question about the overdue shot, without having a usual schedule right in front of us. So, could you post Bailey's usual schedule (both food and insulin), and then tell us what time he was last fed and shot?

Depending on how FAR overdue the shot is - is the food overdue too? - and on when YOU can feed and shoot Bailey, you might need to feed and shoot, and then gradually work your way back, maybe an hour at a time, to Bailey's normal schedule. I can't remember, though, if you can be at home at times you would make the adjustments.

It's best NOT to OVERLAP insulin shots! They should be at least 11 hours apart. Always given with (or, after) food. I shoot 30 minutes after food.

Wed, 12 May 2010 14:29:23 (PDT)

[eileen]

My concern is that if he only had chicken for breakfast there is no carb source for the insulin to be working with.
Most likely you are seeing this decrease because of this. Without a 'normal' meal these readings are not true to what they would be had he eaten correctly.

It is very important to try and stick very close to what they normally eat. This may mean putting some warm water in his WD along with a little chicken so to entice him to eat yet keeping his calories basically the same.

Not knowing what or if he ate his dinner and as Carol says, how much later are we talking about.
Most likely if he ate his regular WD for dinner you would begin to see an increase in his bgs and the low, 1 or 2 units of insulin would be alright.

We need more specific information.

[waynorth]

This is Bailey's 12 hour curve I did from 2:30 AM last night to 2:30 PM this afternoon. That is his schedule as I leave for work at 3:45 AM

TEST 2:30 AM 525
Feed 1/2 cup cooked chicken (wouldn't eat his W/D)
SHOT 3:00 AM 2 UNITS
TEST 4:15 AM 444
TEST 5:30 AM 384
TEST 7:30 AM 216
TEST 9:00 AM 194 6 Hour Mark
TEST 10:00 AM 182
TEST 12:00 PM 168
TEST 2:20 PM 139


He didn't begin to climb today on the new insulin like he did on the vetsulin. He continued to drop throughout the day.

Thanks,
Jackie

[waynorth]

I tried everything this morning to get him to eat something other than just chicken and he simply would not. He did eat regularly this afternoon and I just tested him and he's risen to 384. At 3:30 I went ahead and gave him the one unit my vet suggested.

Jackie

[CraigM]

Jackie,
I know this is a VERY hard decision, especially if you are going to work, or not able to monitor for a few hours. My limited experience with Annie is that NPH runs its course in 11 - 12 hours and her fasting number is frequently in 80 - 130 range. I guess I'd go for safety, as you indicated, and go with 1 or 1½ units. Going from 2 to 1½ is a 75% reduction which is pretty big. What did you give?

Isn't this great fun? :-)

Craig & Annie

[waynorth]

I can check him a couple of times tomorrow morning before I leave for work and of course when we get up. I've just never had Bailey be in a normal range before just before eating and when his shot is due. He is normally way too high. I gave one unit this afternoon and if he's high tomorrow, I'll fell ok giving two units like I did today.

Yes, it's a blast!
Jackie

[CraigM]

Just read that you gave 1 unit. That's pretty safe. I think Bailey, and you, are going to be really happy in the very near future. GOOD WORK!

Craig

[eileen]

ok, When looking at readings taken when everything has not been 'typical' that day one must be careful and not think that this is where the readings would be had everything gone as they should have.

In other words...I still think it is quite possible that your lower readings were do to the lack of carbs this morning. Now this evening since he did eat his regular WD the rise in bgs that you are seeing is from his meal.

Believe me I truly understand picky eaters as Mildred was one for years. I've had to pull most every trick out of my hat to entice her to eat. Some times successful, many times not.

Just try your best to keep the basics of the meal the same with adding enticements.

You can try using a little sardine squashed into the food, Parmasan cheese sprinkled thru out. After feeding my cats canned food I would use the same spoon to mix Mildred's food. Just the smell of cat food on her food would sometimes get her to eat.

Just be creative with 'toppers'. The more you are able to be consistent with feedings the better control you can obtain. As it is said, 'Consistency is the key'.

[waynorth]

This is the first day in two months that he hasn't plummeted to a low an hour after his morning shot, so the new insulin seems to already be having a positive effect. It will take a while, but it was a good move to make.

Thanks so much!
Jackie

[waynorth]

What good ideas. I will try them because this does happen with him quite often. I was looking up diabetic foods today and "Halo" seems to be recommended by many. Does anyone have anything good or bad to say about that one?

Thanks,
Jackie

[k9diabetes]

I'm just catching up... I seem to be running in twelve directions at once lately!

Since what's eaten has a huge effect on the blood sugar levels over the next 12 hours, we can pretty much assume that a curve done when he eats his dog food and his chicken will be different from this one.

Is eating in the morning something he's not fond of?

I'm going to go back through your whole thread before writing too much more but I did want to say that basically at this point you should forget about the blood sugar in the 400s and 500s! Not forever, just for now.

How much insulin you can give always has to be controlled by the lowest blood sugar reading because increasing an insulin dose drives all of the blood sugar levels down - the high ones at breakfast AND the low low ones later one. So the only way to avoid risking hypoglycemia is to give a dose of insulin that leaves the lowest blood sugar of the day in a good spot.

There could be many reasons why he's needing less insulin right now - most of them good news I'd say, like maybe his pancreas has healed up some.

So for now, don't worry about the 500 levels at breakfast. Concentrate on finding a dose where his blood sugar doesn't go too low and on getting him to eat his breakfast.

When did he start eating WD?

Has it always been difficult to get him to eat it or difficult to get him to eat in the morning?

He is certainly getting a late punch from the insulin and probably the ideal will be to arrange for him to have a snack somehow if that's possible or to amend his diet with some carbs to use up some of that insulin earlier on so it's not hanging around 10 hours later.

Natalie

[peggy0]

The ingredents in Halo are good but there are some carbs that may impact the BG. Many here are having success with Blue Buffalo. They have a high protein/low carb version called wilderness and grain free version as well. My dog did well on their weigh control food. The dogs seem to love it and its easy to regulate with it. You can get it at PETCO or PETSmart. They have canned and dry. I mixed mine. :) You've got alot of suggestions. You just have to pick the one the pup will eat. Sometimes your pantry looks like a store front until you get it right LOL we do spoil them!

[Tikobird]

Hi Jackie - Dozer is one of the dogs switched to the Blue Buffalo Wilderness (chicken) dry food from DCO. He absolutely loves the BB all by itself whereas I was adding boiled chicken or green beans to the DCO to get him to eat it. Doze gets 2 cups 9:30 AM & 9:30 PM and has started to remind me again when feeding time is near :)

Lori

[waynorth]

Bailey isn't usually a finicky eater, but once in a while I'm crawling around on the floor following him with different things. People say just leave it, he'll eat when he's hungry. You can't do that with a diabetic dog!

This is day two on the humulin for him.
His first test before eating or the shot was 384. This is from one unit of insulin the previous 12 hour shot. That was a low dose because at that time he was only 139. I came home at the six hour mark today and he had dropped to 164. Six hours later now and he's at 494 before shot or eating. I am going to go ahead with the two units I've been giving him of the humulin (except for the one low time) and test again before we go to bed. If he's up again in the morning that high around 500 and still has to eat, should the insulin amt. be increased? We were starting low to be safe, but on Vetsulin he was getting seven units twice a day.

I will check out the Blue Buffalo food. If he won't eat anything but his chicken, was percentage of carbs should I add at a meal? I'm not home to give treats from one shot to the next.

Thanks,
Jackie

[CraigM]

Jackie,
Remember the amount of insulin depends on Bailey's low. I'd say if the days low is in the lower 100s, you should not increase the insulin. If after a few days Bailey continues to give lows in the low 100s (maybe 90 - 150?), but the highs are in the 400s, possibly a food change would help to flatten the readings.

Remember, nice and slow - takes a few days for changes. Even then you might (likely) see occasional readings that you just can't explain. That's their way of messing with us! LOL

Annie gave me one of those STRANGE readings this morning - 60. She has had a few readings this low before and never "shows" anything wrong, just is her happy self! I did reduce her insulin from 7.5 to 7 and I'm sure she will be fine.

Craig and Annie

[waynorth]

I will keep it at the two units like yesterday, which produced pretty good readings and see what another day brings. If he absolutely won't eat any dog food and just chicken with no carbs in the morning, then should I add in a little bit of carbs with a treat or two? If he's low in the morning when I check him before the shot then I will decrease the units he gets.

There is sure a WHOLE lot more to this than my vet said when his instructions were simply seven units morning, seven units night and you're good to go!

Thanks so much,
Jackie

[CraigM]

As I've said, Annie has been pretty good having fasting numbers in the low 100s. The few times she throws something in the mid 70s, I stay with the normal 7.5units and she returns to "normal" at the next fasting test. I reduced to 7.0 this morning because my wife was watching and she would worry if I stayed at 7.5. LOL

Since it's 2PM here in Portland guess I'll do a spot check.


Craig & Annie

BTW - Cute photo

[CraigM]

2PM = 215. Should have stayed with the 7.5! LOL

Just discovered something. It's a beautiful day here in Portland, Oregon. Sunny blue sky and in the mid 70s. I'm sitting out under one of our trees (retired life is great) and Annie was on the patio in the sun. When I pricked her ear, the blood flowed like a river! Warm ear is great for testing.

Craig & Annie

[Harry]

Hi Craig,

I would appreciate, if you will, just where on the ear do you prick? It just tears me up to prick Fergy on the lip when doing a 12 hr. curve. Thank you.

Harry :)

[CarolW]

Hey, Harry!

Talk to me! Actually, I should put this in your own thread, and will do so, but what I'm wondering is, what is it that bugs you about pricking Fergy's lip?

Usually, it's a LOT easier to get blood from the lip - also, without pain to the dog - than it is from the ear. So people say!

Fri, 14 May 2010 06:10:54 (PDT)

[CraigM]

***Also posted in your thread***

Harry,
I test on the underside of Annie's ear flap. I twist / fold the ear over so I see the bottom because there seems to be less fur on the bottom. Just back from the front edge I feel for a slight ridge and hand lancet there. I think a mechanical lancet pen so close to her ear would bother her. I keep this area on the underside of the ear groomed so the fur isn't too thick. I also apply a very small amount of Vaseline before pricking to help the blood "ball up" a bit. After pricking, I usually do have to lightly squeeze around the spot to get a drop, but Annie doesn't seem to care.

I've tried the lip, but her mouth is so small, and my fingers are too big!

Craig & Annie

[Ladybug]

Hi Harry,

It just tears me up to prick Fergy on the lip when doing a 12 hr.

I tried Ladybug on the paw, she yelped. Did have success on the ear, but she yelped.

Ended up with the lipstick on the inside of her mouth and no yelping! When she sees me get my supplies ready for a test, she jumps up on the bed and waits for me. It's one prick, blood immediately, reading and we're done! Maybe takes all of 30-45 seconds! There are times during a curve that she gets a little antsy, but she is very patient and good about it. She knows she gets a piece of broccoli or a green bean after she gets tested!

The lipstick does not hurt them. There are no nerves on that part of the lip. Maybe Carol and the others can explain it better to you.

Linda/Ladybug :)

[CraigM]

Jackie,
How are you and Bailey doing?

Craig & Annie

[waynorth]

Things are leveling out with the new insulin. His high is about 384 consistently when I check him before his shot or food in the morning. Low seems to hover around 150-174.

It's amazing what food can do and testing at home to find that out. I gave him two Wheat Chex, which he loves, thinking I would add a little carb when he wants just plain protein in the form of chicken. Fifty points those two little wheat chex raised it. Wow. I don't know how long those carbs would effect him, but I'm realizing now how anything that goes in the mouth is going to have an impact. It's a true learning experience.

When I was testing him months ago he seemed to be stable on the Vetsulin, but the last couple of months things went south. I wonder now how long his numbers were really off since I only tested him once or twice a day.

I will keep his diary a while longer to see if it stays the same and then question whether or not there needs to be an adjustment to the amount of insulin he gets.

Thanks for checking on us!
Jackie

[peggy0]

It is amazing how a bite will drive those BGs. And its different for each dog as well. Being a detective for your own dog is the key and I don't know how you do that other than testing at home! Congrats on the progress!!

[CarolW]

Hey, Jackie!

Welcome to the Kibble-Or-Wheat-Chex club!
http://www.coherentdog.org/vek/kubgconsistent.php

and make sure to look at the SECOND chart on that page!

Then you can use the NEXT button near the page top, to see what happened when I stopped feeding kibble between meals!

Then we had a bit of scare with some lows - not hypo, but really getting down there, too far for comfort. I'm working on charting THAT stuff now!

Your numbers for Bailey look REALLY good to me!

Changing stuff gets tricky - change one thing at a time, for best results, so you know what the heck is going on! (I know you know that; I'm sort of instructing myself here!)

Poor Kumbi is getting a LOT of Sticks these days; he says, Throw then; I'll chase them, bite them, and get rid of them! (He's being good, though!)

Sun, 16 May 2010 09:15:47 (PDT)

[waynorth]

With my work schedule, Bailey gets his shot from 1:30 AM to 2:00 AM a half hour after eating and testing. His afternoon shot then is twelve hours later as I get home at noon.

I have always followed that schedule as well on my days off, but once you have two dogs up who eat, then we wait for Bailey's shot, it's party time and there is no going back to sleep.

It would be nice (though if it isn't possible, I will keep this days off schedule) to give his shot later on my days off. When you do something the night before and get home at eleven or so and then you must get up at one in the morning and NOT go back to bed, it makes for a groggy couple of days.

Is there any way around this? Can the shot be delayed at all or is that safe to do?

Any help would be appreciated. It would be kind of cool to actually have a life at times! I know.... selfish, selfish, selfish :)

Thanks,
Jackie

[k9diabetes]

Generally, it's preferable to keep it 12 hours apart. If you have to delay it, you want to change it as little as possible. An hour at most.

How well that works just depends on how your dog is using his insulin and food.

But unless there is a specific insulin/food need that's being addressed by waiting 30 minutes, there's usually no reason to wait half an hour to inject the insulin. Most inject it right after their dog eats his/her food.

Reasons to wait 30 minutes would be a pretty consistent tendency to throw up right after eating or a very sharp drop in blood sugar if the insulin is given right away.

What does Bailey's blood sugar do in the first two to three hours after eating?

Natalie

[ozzi]

Hi Jackie,
I have found that absolute consistency with Ozzi has been key to managing his diabetes. I increased his insulin dose to 24 units of Humulin-N at 8AM and 8PM two weeks ago and his peak insulin BG's 6 hours after injection are consistently running 110-111. I mention this because I think consistency with everything (amount and type of food, timing of food and insulin, exercise, etc.) are critical to maintaining diabetes regulation. As Natalie pointed out, an injection can be delayed a bit, but you will notice that regulation will most likely suffer to some extent, particularly if it's not a one-time thing and occurs two days/week. I don't know your work schedule, but if it's at all possible to figure out times that might work better for you on your days off and incorporate them into your working days so Bailey does get the shot every 12 hours, I personally think that would be a better situation. For example, is there anyone else in the house who could accommodate giving the injections when you're at work? It looks like you get home at noon, so can Bailey get shots at noon and midnight?

I realize it's not easy, and I don't think it's selfish at all for you to want to sleep and have a life on your days off!!! It is difficult, but if there are any times 12 hours apart that you can work into your days on and days off, Bailey's BG will be steadier.

Kevin

[waynorth]

I've just always waited the twenty to thirty minutes after eating because that's what my vet told me to do I guess.

No, there is no one else home that can work in a different shot time. I can't say really yet where his numbers are 2-3 hours after his morning shot because last week he was switched from Vetsulin to Novolin N and then I went back to work so I haven't been home all week to do a curve. I'm starting that tomorrow morning for two days to actually see what he's doing now.

So far, testing in the morning before eating or his shot he is around 325 then drops to maybe 260 when I leave for work - 1.5 hours after his shot. When I get home after work he can be anywhere from 170 - 400. We started out low with only two units so he wouldn't have a low when I went back to work. Doing a curve the next two days should help in getting this straightened out.

So... yawn... here I sit now sleepy and my little angels are snoozing away!!

Thanks,
Jackie

[ozzi]

So... yawn... here I sit now sleepy and my little angels are snoozing away!!

LOL Jackie....aint that always the way!!

I actually inject Ozzi just prior to feeding him. I wouldn't recommend that method if the dog is a finicky eater, but Ozzi has never been. He takes tramadol twice/day so I give him a small amount of his food with the tramadol, inject, and then feed him. Ozzi usually dances around like a nut while I'm preparing his food, so I know he's going to eat. On very rare occasions that he isn't feeling well, I do wait until he eats before injecting, in case he doesn't feel like eating, but as I said, that is generally a very rare event in this house!
Kevin

[eileen]

I realize it's not easy, and I don't think it's selfish at all for you to want to sleep and have a life on your days off!!! It is difficult, but if there are any times 12 hours apart that you can work into your days on and days off, Bailey's BG will be steadier.

Kevin


Sleeping in...a life of my own??? Heck, I chose to toss that out the window nearly 6 years ago with not a regret in the world!

[waynorth]

Sleeping in for me might be four AM... I'd feel pampered!!

[Ladybug]

Hi Jackie and welcome!

I too feel that some days I would love to sleep "just one more hour".

Ladybug and me have worked so hard to come as far as we have....one extra hour of sleep for me would not be worth the injury it could, and probably would, cause her. I worry when the clocks change to DST and back again in the fall!

Ladybug's inner alarm clock goes off at set times during the day - for meals, insulin, walk, lipstick, playtime. Even when I don't test her a lot on a particular day, she'll look at me like "we're missing something today!" LOL!! I don't think she would let me sleep past a certain time! :)

I too am alone, but maybe you could get someone to help you out. I know it's really rough at times, but we have to be strong for our furbabies. They can't take care of themselves, so we have to! Maybe you could grab a nap or two during the day? That may help!

Linda/Ladybug :)

[waynorth]

Oh, I'll survive. Diabetes is nothing compared to Bailey's last two years of chemo and immune supression drugs for GME encephalitis. There were nine pills a day, huge shots I gave four times a month, running home to get him after work and running back to town three times a week for blood tests on icy, winter roads usually and then getting that blood to UPS to overnight to a special lab. But, as you said it's all worth it now as that was then because I still have him with me.

We have been doing a nap on my days off, which they LOVE, and if nothing else I will be able to recite just about every infommercial on TV soon! LOL! Just thought I'd check as I've come to realize there is a whole lot my vet never told me about diabetes until I found this great forum.

Thanks!
Jackie

[k9diabetes]

Your schedule has mine beat. I used to get up every day at 4a.m. for Chris' first meal and injection. That was bad enough. I'm not sure I could be trusted with sharp objects at 2 a.m.!

But I had the distinct advantage of being very good at going back to sleep and Chris was always more than happy to go back to bed too.

That must have been incredibly grueling for both of you. What a good mom you are!

Natalie

[waynorth]

Bailey has been on human insulin now for about three weeks. We started him low at two units to be safe and I've since increased it to three, but his numbers remain high despite my tweaking his food.

Twelve hours after his morning shot, when I get home from work he's at about 350-450. The lowest I can get him on the three units is 170.

Should I try a half a unit increase first or go to four? I couldn't get the syringes with the halves marked, so it would be difficult to do that anyway and have it correct each time.

He was on seven units of Vetsulin. I have three days off coming up and I plan to attempt this then so I can do another curve.

Any advice would be appreciated and thanks in advance!

Jackie

[CraigM]

Jackie,
Your 170 reading is getting close! :) I would go with the ½iu, or even just a ¼iu increase. I know a ¼iu increase wouldn't be possible unless to had the small syringes. Our small dogs, that need such small amounts of insulin, can really benifit from the small syringes. If you can't find them locally, have you shopped online? I bet you could find what you want, at a good price online.

craig & Annie

[Tikobird]

The Relion syringes I use have what look like 1/8 marks; 1/4 marks & 1/2 marks I get them at Walmart - I specifically use syringes that dose up to 30 units they are 29 gauge; 12.7mm lengths...if this helps

[Patty]

Lori,
I'm thinking your syringes must have the 1/2 unit marks?
I think that's the smallest Relion (or any brand) makes...
What kinds of markings are on your syringes?
Our markings range from ½ unit to 2 unit increments, depending on the volume of the syringe. Here is the breakout:

1cc - 2 unit increments
1/2cc - 1 unit increments
3/10cc - ½ unit increments
http://www.relion.com/information/faq-insulin_delivery.htm#4

I wish there were syringes with 1/8 unit or 1/4 unit marks!! I'd be able to stop eyeing my small dose changes. ;)

Jackie, I do agree with Craig, if you can eye a 1/4 unit increase, I'd start small. You can find U100 syringes with 1/2 unit marks on www.hocks.com (http://www.hocks.com)
Patty

[Tikobird]

Your right - 1/2 markings are there ...I didn't have my glasses on & saw all those marks between the bigger numbers.....duh

[k9diabetes]

I vote for definitely no more than 1/2 a unit increase given the low end of 170. It wouldn't necessarily take a lot of insulin to drop that 170 a lot lower.

Chris got 7-8 units and I adjusted by half and sometimes quarter units, using syringes with half unit marks.

That's a pretty big difference between high and low. Down the road maybe consider some tweaking to see if you can narrow that gap.

Natalie

[Noodle]

I would add something with a bit more carb to it. Daisy uses bread with Noodle and Linda used this last night with Ladybug.

Patty


I'm very late to this thread, but wanted to add a belated welcome to you and Bailey :), and a note about the bread when they're BG is running low.

We buy whole wheat and/or whole grain bread. For whatever reason, I've found it works beautifully for our dog Noodle when he is running very low. I give a quick carb first, followed by the slice of bread. I use glucose tabs for convenience, because Noodle really likes them, and because they consistently stop him from dropping further and raise him 15-20 points per tablet. I have syrup on had as well, in case he is ever less responsive and I need to rub it on his gums. But so far he has never shown any symptoms of a hypo - I've just caught it by testing his BG.

I've tried other carbs, but I find it harder to control how high he goes. The bread seems to do the trick without sending his BG zooming in the other direction.

Looks like your getting close to the right does, so like others have mentioned, time to go tiny and slow. Noodle is on a large dose of insulin (32 units). Yet the first time we tried to increase his food, and therefore his insulin as well to match, we overshot. I only increased it by 1 unit, but he dropped like a rock. We had to pull back and then work our way back to normal. It's amazing the difference tiny amounts can make when you are close to the perfect dose.

Noodle used to have big difference between his low and high numbers. It was only with food adjustments that we were able to narrow that range. That low end always dictates the dosage.

[waynorth]

I will look online for different syringes. My vet gave me these and they are UltiCare 1/2cc - 31 guage x 5/16 U 100 Insulin Syringes. There are no half marks and even the other marks are so close together it's hard to see and often I wonder if some air isn't in there despite flicking it with my finger and then pressing the plunger to get it out. You can hardly do that or it all squirts out and you have to start over. My vet said each line should be considered a unit.

Thanks for all the info!
Jackie

[Noodle]

I been forced to use the 50 unit syringes, which only come with full unit markings, since Noodle is over 30 units now. I agree that it makes it extremely difficult to judge half units. If you can't get your hands on some of the half unit syringes or want to use up the ones you have, there are syringe magnifiers on the market that can make it easier. I can't link to them right now because I'm on an ipod, but I know they sell them on Amazon and they are available at places like Walgreen's. :)

[waynorth]

Does anyone know how long after eating you can test and get a true and accurate reading?

Bailey was at 400 this morning before eating and his shot, so I gave him his normal three units and tested him an hour later and he'd already dropped to 214. That concerned me considering he has another eleven hours to go and I had to leave for work, so I gave him so wheat chex to raise it up a little, but it hadn't showed up in the fifteen minutes I waited to test and then leave.

Now I'm going to worry all day :(

Thanks,
Jackie

[Noodle]

Generally you wont see much of a BG bump from food for a couple of hours. Only something sugary and quick to digest would show up in that 15 minute window, but it would also leave the body quickly.

More than likely Bailey's morning meal will be kicking in around the 2 hour mark, so hopefully that will stop the drop from going too low. But I just read through your original thread again and it looks like he has had some frequent fast drops. I'm wondering if his high am numbers could be a sign of a quick drop while you are sleeping and then some rebound. I know you had some success with 2 units but he was higher than you'd like. When dealing with such small doses you often need to tweak it by half units or even quarter units.

An alternative is to adjust his food to find a type and amount that smooths out the curve and narrows the gap from low end to high end. Many of us have had tremendous success with Blue Buffalo. Noodle used to have a wide spread between his lowest and highest numbers. The BB seems to have the right amount of carbs to keep him from spiking high after meals, but also enough protein to have enough "sticking" power to keep him from going too low.

[Patty]

Hi Jackie,
I merged your threads so your info is all in one place and easier to go back and look through.

I agree with Daisy's thoughts. Let us know how he is this afternoon.
Patty

[ozzi]

Jackie,

It is true that it takes a couple of hours for food to start to increase BG, because carbs are complex sugars...they are still sugars, but they take longer to break down than simple sugars, or the sugary things Daisy is talking about. The two times that Ozzi had a hypo event, it took me three hours to get his sugar up from 37 and 45 respectively. I never saw a quick bump in his BG despite giving him honey, frosting, and marshmallow peeps (LOL), however, the insulin is competing at the same time, so I think each situation is a bit different regarding the time it takes to increase the BG no matter what you give to eat. A couple of wheat chex will definitely take some time to have an effect on BG. Hope all went well.
Kevin

[waynorth]

I went to 3.5 units and when I got home he was at 344 and he has been much higher in the past. I was gone all day, so I never got to check his low. Starting Monday I'm beginning a curve on the 3.5 and see what happens during the twelve hours.

What would be a good carb to add to the boiled chicken he normally eats?

Thanks,
Jackie

[peggy0]

Hi Jackie,

The ingredients for home cooked diabetic dog food are typically:


* Whole grains (e.g., pearl barley, brown rice) Lean meat (e.g., skinless chicken, turkey, lean beef) Raw vegetables (e.g., carrots, green beans, broccoli cauliflower) Low-fat cottage cheese or yogurt

The grains, vegetables and meat are the same portions. the yogurt and cottage cheese are 1/4 of the others, so if you are using 1 cup of meat, veg, carbs, the cheese is 1/4 cup.

Some folks mix up enough for 3 or 4 days. Adding carbs, even good grains, will raise the BG. Most of the time it does a great job leveling the spikes if you have any.

Some use pumpkin as a carb vs. the brown rice, oatmeal or barley. Not the pie filling but canned pumpkin.

I use to make ground chicken burgers. I'd mix 2 cups of ground chicken with 1/4 cup of cottage cheese and 2 cups of oatmeal. I'd form them into burgers and grill them. My dogs thought they were at the local burger shop. :)

[Patty]

Oh, I bet they loved the burgers Peggy! ;)

Jackie, there's a book called Dogs, Diet, and Disease that's a good read too. http://www.amazon.com/Dogs-Diet-Disease-Diabetes-Pancreatitis/dp/0967225329

One note on broccoli and cauliflower if feeding it everyday, it's best to cook these (parboil for 3 minutes) because they are considered goitrogenic foods can supress the thyroid.

Patty

[waynorth]

I think Bailey and I will both come and eat at your house!!

Thanks for the ideas and the book link as well. We'll get this licked yet!

Jackie

[waynorth]

I am at my wit's end since switching to human insulin from Vetsulin. I don't know what's going on with Bailey at all. I've messed around with this for two months now and he's gone completely blind now, which raises more questions. Do they go through depression? All he wants to do is lay under a blanket. I've had a CBC and full profile done and there is no infection or anything bad going on internally.

I can test him some mornings and he'll be 134 twelve hours after his last shot and then the next morning he can be 550 with no change in diet. I can give him 4 units in the afternoon when he tests at 550 when I get home from work and somedays he'll still be in the 400's six hours later and then the next day he'll be in a low just two hours after his shot.

What is wrong here? He's eating homecooked food of boiled chicken with some brown rice in it. I've stopped almost all treats except an occassional freeze dried liver, which is pure protein and no carbs.

When he's at 134 in the morning and eats and I have to leave for the day, I don't feel comfortable giving him four units because I know he'll drop too low, so I adjust it to two, but then he's off the charts twelve hours later when I get home.

Does anyone have any advice as to what I can or should do? I am off Tuesday and Wednesday and can do curves again. I tested my meter with control solutions from the company and it's working fine, so it's not that. I also test myself just to see if it's haywire with me, but I'm always in the normal range.

Help, please.
Jackie

[k9diabetes]

With such erratic readings, I would cut the insulin dose down to 3.0 units, keep him on that dose for a minimum of three days and then do a curve.

The goal would be to eliminate any rebound from an episode of low blood sugar. The problem with rebound is that once it occurs, you can have high blood sugar for two or three days afterward.

So you have to wait that amount of time before you can be sure that when you do a curve you aren't seeing the aftereffects of a rebound - that you are then measuring how the body normally responds to that dose of insulin.

What you describe really sounds like rebound is a possibility.

What to do next would be determined by the curve.

And you might need to do a curve and some spot checks or a few curves a couple of days apart to see how stable his blood sugar is once rebound has been eliminated.

It can be hard to get a good dose when using so few units of insulin. Just 1 unit is a 25% change in his dose. Even half a unit is a big change. So may be that going down to 2 units was not nearly enough and he would have done better on 3.

But let's see if you can get him stable with less insulin and then we could work on the problem of getting the blood sugar lower after that.

It will take some time. You have to tolerate some high blood sugar to get there but have the chance to finally get some stability once you're through it.

Natalie

[CraigM]

I know a lot of you home-cook, and we home-cooked for a while two years ago soon after Annie was diagnosed. I always wondered if the food was consistent enough. Seems to me it would need to be "blended" to be sure each cup, or ounce, is the same as the next? Is that a concern?

[k9diabetes]

We used to mix Chris' food with cottage cheese and even on a road trip we measured the canned food and cottage cheese for each meal because I was concerned that premixing a large batch would be less consistent.

[Patty]

Jackie,
I'm sorry to hear about your struggles. Look forward to your curve to see if we can help.
Patty

[eileen]

I know a lot of you home-cook, and we home-cooked for a while two years ago soon after Annie was diagnosed. I always wondered if the food was consistent enough. Seems to me it would need to be "blended" to be sure each cup, or ounce, is the same as the next? Is that a concern?

This is one of the benefits of weighing each ingredient over measuring.

[waynorth]

I will try the three units for several days if I can, but if he's110 when it's time for his shot, even with feeding, the three units may drop him too low when I'm at work and can't see if there is an emergency. That's my biggest fear. But if I have to keep alternating dosages then it's going to keep causing problems?

When I start this curve tomorrow, is it best to of course test before his shot, but then should I feed him and wait and see what that does to his blood sugar and then give the shot or just give the shot and feed and then test an hour after that?

I'm sorry if that didn't make sense, I am so confused anymore. I feel so sad that he lost the vision in his other eye and is now blind. I took him outside yesterday and was running into plants and bushes, just completely lost. I imagine other senses begin to kick in eventually to help them out, but it's painful to watch my little boy.

Thanks,
Jackie

[waynorth]

Pre shot this morning Bailey tested at 319 - I gave him three units and fed him and an hour later he's at 394.

Regarding his food, I mix the chicken and rice equal amounts in a big bowl and then measure out his portion with each feed.

Thanks,
Jackie

[Patty]

When I start this curve tomorrow, is it best to of course test before his shot, but then should I feed him and wait and see what that does to his blood sugar and then give the shot or just give the shot and feed and then test an hour after that?


When you do the curve you want it to reflect a typical day for him, so you don't want to change things up if you can help it.

You'll want to get a fasting reading (before insulin and food), then feed and inject. Then take a reading every 2 hours after this point including fasting blood sugar in the evening.

Jackie, I do have another question...is Bailey's diet just rice and chicken? Are there any veggie's, supplements, or vitamins also given?

Patty

[waynorth]

I attempt to sneak veggies in, but sometimes he won't eat it if they are in there. He's never liked veggies. He does get a good multivitamin every day.

I've tried veggies as frozen treats and he just walks away from them. I'm thinking of trying a puree of them mixed in and see if I can sneak that way.

Thanks,
Jackie

[k9diabetes]

Glad you didn't have to punt this morning. If his blood sugar had still been low on 3 units, you would cut the dose again, down to 2.5 or 2.0. You want to find a dose where his blood sugar never goes low and stay at that dose for three full days.

So looks like 3.0 units worked fine.

Standard curve is a prebreakfast reading and then a reading at least every 2 hours through predinner, preferably on into the evening if you can so you can see how similar the daytime and nighttime response is.

Natalie

[waynorth]

I have tracked him since yesterday at the three units and the numbers yesterday were similar to today. Tomorrow I can actually do a twelve hour or more curve since I'm off.

Today:

Fasting before first feed and shot: 289
Feed and shot
Two hours later: 345
At four hours: 248
At six hours: 429

What would cause him to spike at the six hour mark?

I'm testing in another two hours to see if he keeps climbing or begins to drop again.

Very confusing, but it seems the three units may not be enough since he never even gets in the hundreds.

Thanks for the help,
Jackie

[Noodle]

Hang in there. It can take 3 days or more for a new dose to settle in, so give it some more time. It's good that he isn't going too low on 3 units. I know it's hard to be patient when you see high numbers, but making sure the lows are completely eliminated is the only way to work back to the correct dose. In the end, he may turn out to be incredibly sensitive to tiny dosage changes. Since he is on a very small dose to begin with, it may be a quarter unit that makes the difference and brings him down into good numbers without going too low. :)

[waynorth]

A diabetic friend yesterday asked me why dogs can't do a combo (as humans do) of long lasting and short acting insulin to keep them more stable. Is there a reason why that isn't possible? I apologize if this is a stupid question that's been asked a hundred times already. I've searched the net and can't really find anything about this.

Thanks,
Jackie

[k9diabetes]

The short answer is that they can use combinations of insulin and some do. But a lot of dogs don't need the combination and can even have problems with it.

Different species - cats, dogs, and people - process the same insulin differently. Cats need very long lasting insulins as they process them quickly. Dogs tend to do best on intermediate insulins like NPH and sometimes cannot tolerate any faster acting insulin because it drops their blood sugar so sharply.

If you think of the standard for curves for dogs - a shallow bowl, adding a faster acting insulin would drop the blood sugar much more sharply in the first couple of hours, raising a real risk for hypoglycemia.

But if a dog has a post-meal (post-prandial) spike in blood sugar, then using some faster acting insulin is a great way to better regulate them.

The longer acting insulins often don't work well for dogs either. Lantus works great for some and not well at all for others.

In order to use faster acting insulin, you've got to test pretty diligently at first to determine that there's a need for it and then in the process of figuring out how much to use. And there's some work involved in filling the syringe with two insulins.

Not many vets are advocating for tight control, which is probably the biggest reason it isn't tried. But I would only want to do it if the curve showed a need for it.

Natalie

[k9diabetes]

Be sure to wait three full days before determining what his blood sugar is on 3 units. If there was any rebound involved, it could take that long to see accurate blood sugar readings.

And then I wouldn't raise the insulin by more than half a unit if he's still running high after 3 days.

I've seen 1 unit increases be too much in much larger doses than he's getting. It is a challenge with these small doses, that's for sure. We gave Chris typically 7-8 units and I adjusted in quarter units with syringes with half unit marks.

Good luck on the curve! I'm curious to see if that spike at 6 hours shows up again.

Natalie

[waynorth]

Today is the third day of Bailey's curve. Yesterday I was pretty happy as he seemed to maybe be leveling out. At the six hour mark he even got down to 154 and the rest of the day his numbers stayed in the 200's, which for him hasn't happened in months. However, now I don't know what to do the rest of the day.

He got his 3 units at midnight and ate (same thing as always.) He gets his shot at this time because on my days off I continue to follow my work schedule to not mess him up. We slept for three hours and I just tested him and he's soared back up to 498!

I will test him again in two hours, but my question is if he keeps rising (no wonder he lost his sight so fast with this going on) do I leave him there for another 9 hours until his next shot? In the past, this is where my vet would have me give him one unit to bring him down for the rest of the day to avoid organ damage, but now I don't know if I should do that or not.

Since this has been going on for two months now, organ damage is a great concern to me. I don't know how fast that happens, but I'm scared. If someone could give me some advice I would sure appreciate it.

Thanks,
Jackie

[waynorth]

It is two hours later and he's just dropped to 463. I was hoping it would have been more :confused:

Jackie

[peggy0]

I'm not sure why he would change so drastically at night from what he did in the same day. What was his reading when you fed him?

[O'Riley]

Jackie,

I applaud you for your middle of the night meter readings. From what I've read, most people (owners and vets), only do curves during their own normal waking hours, butd I have recently found the evening-to-dawn curves to be much more informative in looking for Somogyi, and also something called "Dawn Phenomenon". Since I'm still trying to control extreme highs, if I could only do a curve for one-half of a 24-hour period, I would choose 8pm to 8am.

Here's a link about Dawn Phenomenon:
http://www.dlife.com/diabetes/information//inspiration_expert_advice/expert_columns/garnero_0106.html

I'm sure Natalie and those more experienced than I will have way better ideas, but here's my novice contribution:

Cortisol is released at higher levels in the wee hours of the night/morning -- it's a circadian rhythm thing -- and a diabetic doesn't produce enough insulin to counteract the high glucose. In fact, I think most diabetic dogs can't produce ANY of their own insulin making them completely reliant on the exogenous insulin that we provide via shots. If you look at the recommendations in the article that I linked, the one that stands out is food-related. Is it possible that your midnight feeding is adding extra fuel to the Dawn Phenomenon? Could a small purely protein midnight meal with zero carbs, and a slightly larger insulin dose than the daytime dose, drop those readings a bit?

Your schedule probably won't permit an experiment similar to one I'm doing with Riley right now, but this is what I'm doing. Riley's on the Jean Dodd's liver cleanse diet and he eats breakfast anywhere from 8:30am to 10:00am, then gets his shot. Dinner is around 6pm, followed by his shot. So he's getting his shots closer together during the day (9am and 6pm), and he's basically done eating at 6:30pm until around 9am the next morning. This is going against convention, but I was desperate. His readings every morning for the past 6 days have been in the 100's.

~Rose

[waynorth]

Bailey's curve I've done began three days ago.

12:00 prefast reading 289
12:00 Noon Feed and shot of 3 units
3:00 PM 345
6:00 PM 248
8:30 PM 429
10:00 PM 335
12:00 AM prefast reading 331
12:00 AM Feed and shot of 3 units
3:00 AM 298
6:00 AM 264
8:00 AM 216
12:00 PM prefast reading and shot 215
12:00 PM Feed and shot of 3 units
4:00 PM 215
6:00 PM 154
8:00 PM 205
11:00 PM 238
12:00 AM prefast reading 242
12:00 AM Feed and shot of 3 units
(slept for three hours here)
3:00 AM 478
4:00 AM 463
5:00 AM 240
10:00 AM 388
12:00 PM prefast reading 265
Feed and shot
2:00 PM 263


He has had absolutely NO treats during this curve, but something makes him spike just out of nowhere.

Looking at this on the graph I've done, the numbers to me look all over the place now, though without the spikes, he does drop during the day on 3.5 units. Any ideas?

I will test again in an hour, but I go to bed early so that will need to be the end of my curve. If he spikes later I won't know it. I have no idea where to go from here.

Thanks so much for taking the time to help us.
Jackie

[k9diabetes]

Hold steady... I graphed his numbers and there are some trends. I am not sure where the spikes came from but overall he's in a decent range. I've got to go out but will post the chart later.

Organ damage only occurs over long long periods of time. Chris was poorly regulated for an entire year and a half and still went on to live a long life and have many good years.

Natalie

[waynorth]

Thank you so much for the work you're doing on this. What you said about your dog's history makes me feel better.

Jackie

[waynorth]

Thanks for the link you sent. I"m going to read about that dawn phenomenon.

Bailey just tested at 156, which is good, but we need to get to bed so now I will worry that he'll drop lower.

How low can they go before you need to worry?

Thanks,
Jackie

[waynorth]

To add on to Bailey's curve, he was 156 at 5:30 PM, 5.5 hours after his shot. This morning's prefast reading is 368.

Jackie

[waynorth]

I imagine being so high at 368 he spiked again sometime during the night.

Jackie

[waynorth]

So, for four days in a row now Bailey has tested high after 7 hours of sleep. Since I can't test him, I'm assuming that the 379 he was at this morning is dropping down from a higher number. Does anyone think I should begin researching that Dawn Phenomenon mentioned?

For two afternoons now, he's been 156 12 hours post shot in the morning (which for us is 1:00 AM because of my work schedule.) Yet, 12 hours post shot while sleeping at "our" night (5:30PM - 12:00 AM) he comes in twice that amount.

Any ideas? I do have more test results from the time I'm home from work and going to bed if that will help, along with the three day curve I did.

Thanks,
Jackie

[Patty]

Jackie,
I do think posting your numbers would help.
It may be that with the lack of activity more insulin is needed at night than during the daytime.
Patty

[waynorth]

I'll post the numbers later, but I doubt that's a cause. Since going blind this week, he doesn't move out of his bed unless I make him when I get home from work and then he goes right back there.

Jackie

[k9diabetes]

Here's a chart of the three days of curve.

http://www.k9diabetes.com/userimages/Baileyon3units.jpg

The spikes are really odd but the main trend of those two days is somewhat similar, one is just shifted a bit higher than the other.

I don't think this is a Dawn Phenomenon and there's some question as to whether dogs do that.

Erratic blood sugar can come from high triglycerides or from other infection or inflammation or allergy issues. And, of course, from getting hold of something to eat... doesn't sound like that's the case here.

I worry that Bailey seems so lethargic and wonder if something else could be going on.

Natalie

[eileen]

In the weeks leading up to the discovery of Mildred's high triglycerides...

Lethargic (very), no energy to walk out to the lawn to pee so would take 1 step out the door and do her business right on the porch.

Glucose levels up and down...all over the charts with absolutely no control.

And finally her stroke, could not walk a straight line, walking only by circling to the right with her head held tilted.

Three weeks after this discovery and special diet she was a puppy again with bgs back in a wonderful range.

Testing the triglyceride levels is a simple blood test in itself. I would recommend it to anyone where there may be a question and not let it get to the point where Mil did...by having a stroke.

[O'Riley]

Eileen...I don't want to take this thread off in a different direction, so could you please post a link to the thread about Mildred's diet? I tried searching and did find a thread about your experience wtih Humalog which I would also like to read about. Thank you!
~Rose

[eileen]

Eileen...I don't want to take this thread off in a different direction, so could you please post a link to the thread about Mildred's diet? I tried searching and did find a thread about your experience wtih Humalog which I would also like to read about. Thank you!
~Rose

Guess because Mildred has no 'thread' of her own.

I've always been one to learn by reading, rarely asking for help but always willing to offer my experiences to others.
Any info on Mildred is just here and there thru out other threads where it may be relevent.

If you want to start a thread with questions I'd be happy to answer.

[Patty]

Eileen,
Here's Mil's thread http://www.k9diabetes.com/forum/showthread.php?t=374. As you said, you don't really use it. I used it to post a question re: her Humalog back in Jan.
Patty

[waynorth]

Hi all... I'm still struggling with Bailey and have done curve after curve after curve. I have twelve hours of the day down with really good numbers, but it's the second half of the day that goes out of control.

He eats, gets his 4 units of Novulin N and remains in good numbers. He should be climbing at the twelve hour mark before his next feed and shot, but it's like that's when he's peaking. For example, he can only be at 116 when it's time again for his shot at twelve hours. I wouldn't dare give him four units because even with food, I know from experience it would drop him too low. It has in the past.

So, I give him one or two units to account for the food he's taken in, which is normally boiled chicken with either brown rice or sweet potatoes, but then when I get home from work ten hours later he's off the charts well above 400 or higher. the one or two units isn't holding him, but giving more would put him into a quick low before I leave for work and that's frightening.

What can I do?????? He has trace ketones in his urine, so I'm very concerned about these daily high numbers.

Does anyone have any ideas?

Thanks,
Jackie and Bailey