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-   -   Glucose above 400 - Need advice (http://k9diabetes.com/forum/showthread.php?t=7740)

ro-ray 08-25-2018 01:12 PM

Glucose above 400 - Need advice
 
I'm looking for advice/guidance/feedback on adjusting insulin dose. I'm very concerned that my dog is going to slip back into ketoacidosis. I've been quickly (see attached charts) increasing her dose (now at 16 units, 2X/day). Ketoacidosis vs hypoglycemia. I know she almost recently died from ketoacidosis. Am I increasing her dose to quickly? Should I keep increasing? Same rate? I'm hoping someone has some valuable experience and knowledge to share.

I'll try to pack in as much info as I have.

Dog: Female Lab/Collie mix, ~11 years old, 47 lbs
Diagnosed with diabetes August 1, 2018.

Symptoms included clear sticky residue where she slept, constant thirst/drinking, large increase in appetite and decrease in body weight over the course of of couple weeks or so (was at ~50 lbs)

Went to Emergency hospital 4 days after diagnosis because she went into ketoacidosis. She was throwing up (yellow foam-ish) for over a day and when she started throwing up water after drinking (she couldn't even keep water down), I took her in. She was on IV with antibiotics and short/quick-acting insulin for the 2.5 days.

On August 6, 2018 I started managing (or at least trying to) her diabetes.

Monitor: Alpha-Track 2

Test sites: calluses on elbows

Meals (2x/Day, every 12 hours): ~0.15 lbs Merrick Beef and Sweet Potato (dry), 0.2 lbs Newman's Own Organic Beef (wet), ~.3 lbs 85% lean beef with fat most drained after cooking (Costco) - handful of baby spinach chopped up and mixed in.

Insulin dose: I started out at 5 units 2X/day on Aug 6, and I'm now at 16 units 2X/day on Aug 25.

I've attached images showing a graph of glucose readings and insulin dosing, in addition to meal size and exercise. A full-size, normal meal will show as a value of 300 in the charts, along with a typical full activity/exercise period (which she hasn't had since diagnosis). Insulin dose values use the second/right side y axis.

The nutshell of the charts is that the first week of treatment may have been a bit of a "honeymoon" period, or effects from antibiotics, etc from here hospital visit. 5 Units seemed to be having an effect but very shortly after her glucose shot back up around 400 and the Novolin-N didn't seem to be having an effect so I've been continuing to increase her dose by 1 unit every day or two until I consistently get readings below 300.

The first chart is for Aug 6 to Aug 18, the seconds is for Aug 19 to Aug 25 (now).

Ah, dooh, can't seem to upload images. Sorry for the inconvenience. Table data from excel in following message...

ro-ray 08-25-2018 01:29 PM

Re: Glucose above 400 - Need advice
 
Unfortunately, I wasn't able to paste in the excel data so that it was readable. I have approximately 100 readings from Aug 6 to Aug 25.

Here's the last two days

Glucose Insulin
12AM 388
10AM 514 15
11AM 438
2PM 378
5PM 357
7PM 349
9PM 446 15
11PM 398

9AM 421 16
Noon 303
2PM 257
4:30PM 376

MikeMurphy 08-25-2018 01:52 PM

Re: Glucose above 400 - Need advice
 
Hi and welcome to the forum.

A conservative starting dose of Novolin N for a 50lb dog would be 50 x .20 = 10 units twice daily.

The protocol that we like to follow to get to regulation is:

- stay on the current dose for 5 to 7 days.
- do a 12 hour Blood Glucose curve, starting at fasting and then every 2 hours until the next meal.
- evaluate the results
- if necessary, raise insulin in .5 to 1 unit increments, based on the lowest BG reading
- keep repeating this process until BG readings range from 150 to 250 for most of the day.

Based on your current readings, it looks like you can continue to increase. However, it’s really important to let the insulin settle in for 5 to 7 days, so your dog’s body can adjust properly.

Good job testing. Just make sure you follow the proper protocol.

What’s your dog’s name?

ro-ray 08-25-2018 03:02 PM

Re: Glucose above 400 - Need advice
 
Thanks very much for the quick reply.

Her name is Elee (aka's: The ferocious One, The Colossal One, Beast, Dog, Dog who never shuts up while on the boat).

In re the 5 to 7 days. Thanks, I hold to that and hope it continues to drop.

Her glucose just (last night) started dropping below 300 when I increased her dose to 16 units after 1.5 days at 15 (and previously 2 days at 13). In 2 weeks I've went from 7.5 (last prescribed 2 weeks ago) to 16. I increased so fast because because her lowest glucose for the day was 350 or so (for weeks), and she was averaging over 400. Additionally, she started getting dandruff, which was a precursor to her going into ketoacidosis (I have urine test strips, and so far she's OK), so I kept increasing every day or so until she got under 300.

Just to confirm, are the guidelines to stay at the dose for 5 to 7 days even if all of her glucose stays above 400, with exception of one or two in 350'ish range?

I'm not trying to put anyone on the spot, I just don't have access to knowledge and experience (my last 3 vets didn't have any idea about the AAHA guidelines for NPH/Novolin-N and they started me at 5 units for the first 2 weeks).

jesse girl 08-25-2018 03:24 PM

Re: Glucose above 400 - Need advice
 
Yes 5 to 7 days is the normal settling time for a dose

If your dog is a larger breed with numbers above 400 in a complete curve you may have been able to give more than one unit and up to as much as 2 units

Now upping the dose by one unit after a couple days may not be a problem if your dog is a large breed but once you see anything in the 200s your going to have to give that week to settle and if you suddenly see things in the lower hundreds or lower you may have to lower the dose just to be sure you did not pass what is needed

When resistance is broken sometimes the dose could be to much but you are testing sugar at home so you should catch any lower trends

MikeMurphy 08-25-2018 03:36 PM

Re: Glucose above 400 - Need advice
 
Right. Stay on the current dose for 5 to 7 days and then do a 12 hour curve. She’ll need that amount of time for her body to adjust. Some dogs can take even longer to adjust. You don’t want to go past her proper dose. This can cause rebound(big swings in blood glucose). Getting Elee close to being regulated is more of a marathon than a sprint. It takes a lot of patience:)

It’s ok to test a couple times a day, maybe at fasting, before her next curve.

Thanks jesse girl. You and I were both typing at the same time

CraigM 08-25-2018 04:57 PM

Re: Glucose above 400 - Need advice
 
Welcome to the forum!

You said you are using Novolin-N, just want to be sure you get / know about Novolin-N from Walmart. Itís $25 for the standard 10ml bottle. Syringes are very affordable there as well.

Craig

CraigM 08-25-2018 05:09 PM

Re: Glucose above 400 - Need advice
 
One other suggestion is to make the meals as repeatable as possible. I donít know if you are estimating the weight of the ingredients, or actually weighing them on a scale? I used a kitchen scale for my Annie.

You didnít mention anything about snacks / treats. Is Elee getting anything between the two meals? Annie enjoyed a tiny piece of chicken, or piece of cheese that should be diabetic friendly.

Craig

ro-ray 08-25-2018 07:42 PM

Re: Glucose above 400 - Need advice
 
Elee - 11 yrs old - 47lbs - lab/collie - diagnosed 1 Aug 2018 - now on 16 units Novolin-N 2x/day
----------------------------------------------------------------------

Everyone, Thanks very much for the valuable and quick feedback. After getting 2 consecutive readings below 300 today, Elee is noticeably more her typical self, but still not fully back to her normal energy level.

Consensus is for me to hold at 16 units for at least 5 days. Thanks for the confirmation and piece of mind. That's our plan.

In re Novolin-N and Walmart, yes, thanks. That's a great tip. Fortunately my pharmacist at Costco didn't fill my first prescription and told me the same thing, so I saved $100's just by having a great pharmacist.

In re her meals, I don't weigh them but I'll check Amzn for something inexpensive. That will help remove one questionable variable. Thanks. As for snacks, the last 3 days I've been giving her about 0.15lbs (~6 small pieces) of BBQ steak (a lean cut) between her 9 am meal and 9 pm meal, usually between 3 and 6 pm. I stopped all her other snacks when she was diagnosed and only give her protein (like bbq steak, no seasoning or marinade). She's thrown up 2 or 3 times since she got out of the hospital (Aug 6) and it was yellow foam and one time had some grass (I try to keep her from eating it). My guess was that her belly was really empty and she's been inhaling every meals so figured low/no glycemic snack might help. Forgot to mention that the throwing up also added to the urgency and my decision to increase the dose at a faster rate.

After doing a lot of reading here, I realize it's a marathon, but watching her go through a weekend at the hospital with ketoacidosis has made the race to under 300 feel like a life or death sprint. The information on this site is providing the best guidance I've received thus far. Thank you all very much.

btw - is there a way to upload pics. I have 3 weeks of data, with 4 to 6 glucose readings every day (along with meal relative size and relative exercise). The data provided by other users has been very helpful. I hope I can provide helpful data in return.

ro-ray 08-25-2018 07:56 PM

Re: Glucose above 400 - Need advice
 
Alas, I found out how to upload and link pics (hiopefully). Here's Elee's glucose readings with insulin dosages (right y axis). The values for exercise and meal size are just relative numbers, with 300 being a full meal size and normal high intensity exercise.

Aug 6, 2018 to Aug 18, 2018 (left y axis goes to 600, hard to read, most values are under 500)
http://k9diabetes.com/forum/picture....pictureid=3353

http://k9diabetes.com/forum/picture....pictureid=3353



Aug 19, 2018 to Aug 25,2018 (today) (left y axis goes to 600, hard to read, most values are under 500)
http://k9diabetes.com/forum/picture....pictureid=3354
http://k9diabetes.com/forum/picture....pictureid=3354


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