Mik is gone...

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Many thanks, Natalie, Kathy, and Admin,

Yes, a lot to absorb. Wife use to say that she and Mik were kindred spirits, because they both ate like birds. Little nibbles here and there, just enough. That was fine, but with diabetes, it tough.

[Mak and I are the same--put it before us, and we eat it]

I knew that 5 units was too high on empty stomach, and have been watching him closely today. He is still gulping water, but the little rascal is either hiding his urniation in another room or holding it.

I am armed with test strips and following him around.

I am sort of planning to reverse the process a bit, worried about his miniscule meal in the am, and that I must go for my p/t job 3 times a week.

I fully realize that scheduled regiment and routine are critical, and will pursue that. But for the short term, while monitoring, I was planning on seeing what he will consume for the am meal, and adjust insulin accordingly.

I have zero chance of him eating a full meal in the am, so if it's a quarter, then about a quarter of the insulin, or about 1 unit.

That way, while gone, I should not worry about hypo.

At home, give him the larger meal 2-4 or so, and the "balance" of the daily insulin.

Does that sound at all practical? Or dreaming?

BTW: at 4:45 pm, Mik decided he was finally hungry, and ate a full jar of baby food and about 9 crumbled vitabones.

[vet said if nothing else, vitabone are not enough, but healthy for the short term]

[k9diabetes]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

It's possible to do it that way... what makes it difficult at this point is we don't yet have any information on how Mik will handle the insulin, with or without food.

I like the idea of giving him 1 unit with breakfast if he eats anything and no insulin in the morning if he doesn't and then giving him some amount of insulin in the afternoon with dinner.

I still worry that 5 units is too much to start with... I'd feel more comfortable with no more than 3 units until you know more about how it will affecthim.

In the short-term, given the ketones, there is a need to get his blood sugar down fast. But not too fast as that's dangerous. And after a day or two, it could be too much even with a full meal.

You could simply stick with one meal and injection a day for now and see how it goes.

Most likely you will see better blood sugar in the 8-10 hours after injection and then the blood sugar rising as the insulin wears off after that time. So you would see less glucose 4-6 hours after a once-a-day injection and then a lot more glucose in the urine 14-23 hours after that one injection a day.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

It has been 9 hours since the 5 unit insulin. I have searched this old house for puddles or wet carpet to test. Nothing.

As usual, Mik is messing with me...

Before this, he was very regular in his "place" but with drinking all the water, he cannot seem to control urinating.

Until today

Yes, I feel comfortable with the 1 ut in the am, then testing if possible and more in the pm

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Finally, 10 hours after 5 units

ketones--trace, very close to negative [15 seconds]
glucose --1000 mg/dl [30 seconds]

So, ketones look good, but glucose high/bad?

Means....?

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert,

I would say you have a very encouraging sign there that the ketones have come down from last night's moderate to tonight's trace/almost gone. I don't recall that you'd given us a glucose reading last night (and to be honest, we were all concentrating on the ketones because of what they can do). Last night, Mik's glucose must have been higher than what you read tonight.

You bet we'd like to see better numbers than this, but hang on, because we will. Insulin takes some time to show its full effect. You may not see the full effect of the insulin on Mik's bg's for 2-3 days or more. You'll see things improving, just as you did with the difference in the ketones from last night to now, but the full effect of that insulin on Mik's bg's will probably take a little longer.

When you inject insulin under your skin, it's called an insulin depot. You can think of it like you would a gas tank of your car because like the engine, when the body needs it, it draws from this "tank". Mik just started filling his up less than 12 hours ago.

When you've been using insulin regularly for a while and you do something like forget a shot or if you have an accident where you get part of the shot to the pet or even where all the insulin winds up in the fur instead of under the skin, it's this "tank" that keep you from needing to re-regulate. For a couple days after that, you'll be getting higher than normal numbers, but that "tank" or depot is what keeps you from running into bigger trouble if and when something like this happens.

I would believe Mik has had his bg's come down since his shot because he's eating and you're not finding anywhere he's had an accident in the house. As his bg's continue coming down, you will see that he needs to drink and "go" less.

So while we are still fighting the bg "war", you have had a victory!

Kathy

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Many thanks, Kathy.

I did not have the glucose reading last night because I bought the correct strips, but when I came home noted they were out of date. Took them back and they handed me another box. It was later when I noticed this version did not have glucose. Returned today, so these are my first glucose readings.

We all feel better here now, thank you, and your analogy of the gas tank makes sense. Thanks.

[eyelostit]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Hi Robert,
Glad you are feeling better than yesterday, it will take a little time for the BG to come down, and your understanding of diabetes you posted was right on target !

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Thanks, eyelostit,

readings after 11 hours

ketone--negative
glucose, just below the 1000 color--a bit lower

[BaileyBear]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

That's wonderful, Robert - no ketones is a very good thing. The blood glucose regulation will come with time. You're doing great...especially with everything you have had thrown at you all at once! A few more days of the insulin in Nik's system and he will probably start feeling a lot better. After that, it's just a matter of patience and time to find the right dose and a routine that works for you and the pups.

Hoping you all get a decent night's sleep for a change.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Many thanks, BaileyBear,
This forum has been Mik's life-saver, and my sanity-saver.

[BaileyBear]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Many thanks, BaileyBear,
This forum has been Mik's life-saver, and my sanity-saver.

I know exactly how you feel. I think Bailey would still be sailing in the 500's and I'd be in a rubber room by now, if I hadn't found this board so early in the game.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

My first injection coming soon this am, and unfortunately, a mandated long day at my p/t job.

Perhaps dumb question #1: if I cannot get Mik to eat anything [and historically, this could happen] what if I gave him a tablespoon or two of maple syrup? This has about 50g of sugar per tblsn.

My plan is a reduced insulin depending on what he eats, but if he eats nothing?

If the insulin "must" have glucose in the body to function, would this work?

Mik is unlikely to urinate this am--he never does, so dumb Q#2: how long after the injection is it "safe" to leave him, i.e., how long before any negative effects would happen--if they happen--after the injection?

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert,

First of all, if you can't get Mik to eat, you CAN give a reduced insulin dose. There is a bodily need for insulin called the "basal", or the insulin the body needs without taking food into consideration.

http://www.intervet.com.au/binaries/82_103335.pdf

This is from Intervet, Australia; Caninsulin and Vetsulin are the same product with different names. Most of the world knows it as Caninsulin, but it's Vetsulin in the US.

Page 15-

"If the diabetic patient is unable or unwilling to eat due to illness, administer a lower dose (approximately 30% of the normal dose) until appetite is restored."

Here you see them talk about the basal dose of insulin.

The problem with giving Mik sugar is that it's only a temporary fix. There are 2 types of carbohydrates: simple and complex. Sugar is one of the simple ones while things like bread, rice, pasta, potatoes and so on are the complex ones.

The simple ones are used very quickly by the body and also leave it quickly. The complex ones take longer to be digested, so they don't start producing glucose almost immediately, like the simple ones. The glucose that's produced by the complex ones also stays in the body a lot longer than what simple carbs produce.

What's told to people when they discover they're low is to first of all, take a source of sugar (simple carb that's fast to raise bg's). This gets their bg's up from a problem point quickly. But the sugar source works fast and leaves the system that way too, so we don't have anything to hold up the bg's and keep them higher, thus preventing another slide to low.

Not until we take some food with some complex carbs in it. People are told to have a sandwich (complex carbs in the bread of it) about a half hour after they take the sugar source.

So for Mik not eating and just getting the syrup, there would be no food "behind" that syrup to keep his bg's up and away from going too low.

Now on to the basal insulin question, which I'll post separately to keep this from running on and on like a freight train.

Kathy

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Many thanks, Kathy.

Looking at Mik right now, he is totally out--as he always is this time of day. I will wake him shortly and try for food, but wanted to first hear from the forum gurus.

Thanks for the quick reply, and I understand it.

So much for my maple syrup idea. I am trying to think of a complex carb that he might eat, and I'm already planning on 25% or about 1 unit.

Odd this timing worked out this way. My job normally requires me on site [40 miles away] by 7, or 8 at the latest. So, I will usually have to get this done by 6-ish.

Today, I'm working until 5 or so, and told them I will be in later this am.

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Now let's talk basal insulin. As you see above, it should be about 30% of the usual dose. If we take Mik's total dose of 5 units, that works out to 1.5 units BUT since this is all extremely new to you, I would go at it this way to make sure Mik doesn't have problems while you're at work.

We did these tables of insulin starting doses recently. They're based on starting insulin at 0.25 to 0.50 (1/4 to 1/2) unit of insulin per 2.2 pounds of body weight.

http://petdiabetes.wikia.com/wiki/Case_Talk:Niki

The closest weight to that of Mik is the 10 lb /4 kg one which says 1-2 IU. When I take 2 and multiply it by .30 (for the 30%), I get the result of 0.6, or 6/10 of a unit of insulin. I would round that down because it would be very hard to find a way to get .6 IU of insulin in the syringe and make it 0.5 IU, or one half unit of insulin.

Where you're most likely to have issues is when the insulin is "peaking" or when it's working hardest. For the intermediate-acting ones (Lente & NPH) this is around 4 to 8 hours. When we get to that point and there's more insulin than food, this is where a bad hypo can happen. As you saw in an earlier post, the 6-8 hour area is where Intervet suggests the larger meal be fed; this is to try to be sure there's enough food on the way to handle the one daily dose of insulin that's going to be "peaking", or working hardest.

Am going to suggest something because you are on the once a day plan-do you think it would be easier for you to try moving Mik's once daily to the afternoon or early evening when you're going to be at home?

Kathy