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-   -   Sissy became an Angel December 29, 2016 (http://k9diabetes.com/forum/showthread.php?t=5557)

stylynjm 11-17-2012 11:57 AM

Re: Sissy's Mom
 
Thanks all..I am home with Sissy all the time,so see every little thing!!! Maybe good,maybe not.lol. she can't get any snacks,no food left around,as much as she would like it.I do feel we r moving in the right direction.she takes awhile to adjust to changes I am discovering. Do u usually wait until u get within a range to make twecks to food??

Cebe 11-18-2012 01:31 PM

Re: Sissy's Mom
 
Waiting re: food - yes and no. I would wait on food changes with a newly diagnosed dog until you get to a point where the insulin can't be changed and I think you might be at that point.

sorry if my last post was a little short. I am feeling a little bad because I pushed you so hard, thinking we could solve the problems with a few behavior changes, but it looks like there's something else going on. It is possible she may need a whole unit difference between morning and night, but unless you're willing to a 24 hour curve, we won't know how low she's dipping at night.

And it is possible that perhaps she's exactly opposite of my dog, who rises at night. Maybe your dog is dipping at night and the large numbers you're seeing are a reaction that. Again, we can't know unless a 24hr curve is done.

With regard to food, tell us what you're doing and what you think you might want to change?

stylynjm 11-18-2012 03:27 PM

Re: Sissy's Mom
 
Thank u so much Cebe, I am hard and fast to 6.25 a.m. and p.m. she is staying in the 200-300's a.m. fasting,and coming down to 111,159, the last 2 days. I am wanting to stay with that a few more days( I'm thinking she adjusts slowly). Then I want to do a nite curve,and day curve before a raise.depending on nite curve,possibly 6.5 p.m. only. During the day she has been 200's around 2 pm, and except for yesterday,lower at supper.I have stopped green bean treat when I test,want to see if there is a difference.
At this point I have more to do before messing with food,but realize it is out there as an option.:):) vet is with me as far as knowing I want to cover all bases and go slow. I drive her crazy with questions too!! Thanks forum:)

stylynjm 11-18-2012 03:42 PM

Re: Sissy's Mom
 
I do have a question about onset and duration. When their numbers during the day go above their morning fasting number,does that mean the insulin has been used up??

Ps: Jesse girl,ur post was just what I needed. Thank u:)

Cebe 11-18-2012 04:14 PM

Re: Sissy's Mom
 
Not necessarily. depends when you're seeing the numbers go up. Going up toward the pm fasting may mean it's running out. Going up early after the shot may mean that the insulin isn't absorbing as fast.

stylynjm 11-18-2012 05:07 PM

Re: Sissy's Mom
 
No,she goes up the first hr,but then down.then sometimes,not all the time up between hr 8-12 she goes up. Cebe,don't feel bad,u all have moved me through my own fear,to deal with this disease.I talked to a specialist tech in san Diego and she said almost without exception a dog should get insulin right after food!! That being said, this forum has been immeasurable help and support for me as it is for so many of us struggling with this new addition to our pups lives.I will always value the thoughts and ideas from all of u and look forward to the day I can contribute,but I guess that takes time.:):)

Cebe 11-19-2012 05:52 AM

Re: Sissy's Mom
 
So, up initially, then down, and a possible spike at the end. That sounds like the food is being digested fast and the insulin is not acting as fast as the food, and it also sounds like it's running out, but if the numbers at the end rise into the 300s, I wouldn't worry too much about the end spike. If they shoot into the 400s or 500s, then it might be worth addressing.

BTW, what are you feeding her?

stylynjm 11-19-2012 06:05 AM

Re: Sissy's Mom
 
Yes Cebe,exactly right.I feed dco kibble.
I did a nite curve. My alarm failed me at midnight,but here r #'s.
Last night fasting,before supper, 381. All alphatrak #'s.
Then food and 6.25 units
9 p.m. 394
2 a.m. 372
4 a.m. 285

Will get 6 a.m. and post....I expect about 220????6 a.m. 306
I believe this is an average nite from all the previous periodic #'s checks.
I'm surprised by the rise at 6 !!

stylynjm 11-19-2012 09:04 AM

Re: Sissy's Mom
 
It appears that 6.5 might help lower #'s.I think it would be a safe raise,given her #'s. Vet is for it if I am ok with it. Any ideas about the fast food,slower insulin. Add 1 tblsp chicken in am?

Cebe 11-19-2012 11:04 AM

Re: Sissy's Mom
 
More food is not what you want to battle a fast digestion. So, hold on more food, and see how 6.5 does. :)

stylynjm 11-19-2012 02:19 PM

Re: Sissy's Mom
 
6.5 p.m.only. how do u correct for insulin running out hrs 8-12????

Cebe 11-19-2012 02:49 PM

Re: Sissy's Mom
 
I honestly don't know, and I may be having the same problem with the novolin. I will be doing a curve on my dog soon, now that I've raised her dose.

It could be that the way it's handled is to use a different type of insulin, but I have no experience with that. Others may have better experience, and your vet may be able to recommend a different insulin that will be more long-acting.

But, let's see how she does on 6.5 in the evenings for a while.

stylynjm 11-19-2012 03:03 PM

Re: Sissy's Mom
 
Thanks,yes I also have call in to vet.I just don't want to move to fast. I will try 6.5 at nite.will post results.:):) good luck with urs.:):) let us all know how its working.I've seen several posts about novolin,however,aren't some of the other insulin a lot more expensive.??

momofdecker 11-19-2012 03:29 PM

Re: Sissy's Mom
 
Decker uses levemir. We use the 10ml vial though I think most levemir users use the pens. Decker started at 5u of the levemir but was up to 10u at one point in time. He is currently at 4.5u. The 10ml vial cost is $135.00 - upfront cost is a lot more. Having said that, he uses 1/4 of the amount he did with the NPH so it lasts a lot longer. The levemir, being a clear insuiln, and in our experience, also lasts beyond the 42 recommended days. Seems that when all is said and done the cost comes out around the same in our situation. Other cosiderations...levemir requires a prescription. If you break a bottle - the replacement cost is much more. Levemir, being four times as potent, is not to be taken lightly. With the 4.5u we don't have to struggle with the micro-dosing, but many levemir users do. Decker also gets 12 hours of duration out of it where many dogs do not. So there may be potential costs to have to use humalog or R to cover the gap.

stylynjm 11-19-2012 04:07 PM

Re: Sissy's Mom
 
Thanks for input and info.apparently several of us r having question about that 10-12 hr high,although sissys #'s overall r getting much better,100-300's. I am not done with novolin yet,lol,I think there is more to try.:):) definitely appreciate ideas.. :):)

k9diabetes 11-20-2012 04:45 PM

Re: Sissy's Mom
 
I am going to post an image of a sample curve - part of the curve is a miscellaneous choice of readings but the first ones are Sissy's readings posted yesterday for the morning.

In this curve, the insulin has good duration, which is defined as the blood sugar returning to a level no higher than it started out. So if the blood sugar starts at 381 as Sissy's did yesterday, the NPH has a good 12 hours of duration as long as the blood sugar is basically the same or less at dinner time. In this case, hers was 306, so she might actually have had some insulin action from her breakfast injection still working at dinner time.

It's somewhat counterintuitive... it's not that the blood sugar should never go up during 12 hours, it's a matter of how much it goes up and relative to where it started.

So if there's an off day and blood sugar starts at 600, you can't expect the same dose of insulin to bring that blood sugar to the usual 300 by dinner time.

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

k9diabetes 11-20-2012 04:49 PM

Re: Sissy's Mom
 
It's also important to remember that meters are not highly accurate instruments. More than accurate enough to be useful, but not so accurate that there is any meaningful difference in readings of 394, 402, and 380.

Managing blood sugar is all about the "big picture" - trends over time, patterns, and meaningfully large changes in blood sugar.

Sissy's numbers from yesterday in the morning are a dog who needs more insulin. It's fairly flat with some of the readings being completely steady realistically. So no need at this moment to correct food or insulin based on these numbers.

That may change as the dose goes up, and it may very well be that Sissy's response varies from day to day. That's pretty common.

Which is when you get back to focusing on the big picture... what does she do most days? An out of the blue blip one day isn't cause for concern. They happen, to every dog. When it becomes a trend, a pattern, then it's something to worry about.

Natalie

k9diabetes 11-20-2012 04:58 PM

Re: Sissy's Mom
 
I didn't post this earlier because it's an atypical curve that shows what was likely either a rebound or an intervention with glucose by the vet in response to a low. But it demonstrates what is considered to be the duration of the insulin and nadir of blood sugar, backing up the definition I have been using.

This is from the NAVC's Clinician's Brief article by Thomas Schimmerhorn at Kansas State University.

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

So please note that in this curve a low blood sugar event occurred and glucose was likely added to the bloodstream, either as a rebound by the dog's body or by veterinary intervention.

It's also important to remember the discussion in the Clinician's Brief article that blood sugar at any one moment is a combination of multiple factors:

Quote:

Serum glucose, at any single time point during the GC, represents the sum effects in the rate of:

- Exogenous insulin absorption - how the injected insulin is absorbed

- Intracellular uptake of exogenous and endogenous insulin

- Insulin degradation and elimination

- Intestinal glucose absorption

- Endogenous glucose production
(glucose released from stores in the body by the liver)

- Tissue glucose uptake and utilization
Another reason to stick with the big picture! ;)

Natalie

stylynjm 11-20-2012 05:04 PM

Re: Sissy's Mom
 
Thank u Natalie,
Wow,she's not doing to bad just a little high still..the graph really made sense,and the explanation of the difference between the highs and lows.I am going to go to 6.5 at p.m. only and see what it does to daytimes. :):)

Cebe 11-20-2012 06:59 PM

Re: Sissy's Mom
 
Thanks for posting that info! Extremely helpful!

stylynjm 11-23-2012 10:30 AM

Re: Sissy's Mom
 
I started Sissy on 6.5 p.m. only last nite.
Before supper last nite.. 313 at2
9. P.m. 412
4 a.m. 558
6. a.m. 437. Before breakfast
9 a.m. 412

Will I have to do this for a few days before she starts to settle?? I just hate these really high #'s. I will see how low she goes today.

Cebe 11-23-2012 11:43 AM

Re: Sissy's Mom
 
I find it so strange that your dog's bgs go up so much at night some days, but then other days, they seem normal.

I would definitely give your dog at least 3 days to settle into a change, but there might be something else going on here. I could just be, as Natalie was explaining, that your dog needs more insulin overall.

Also, it might be time to start looking at what you're feeding. Tell us about that.

stylynjm 11-23-2012 12:56 PM

Re: Sissy's Mom
 
When Sissy was diagnosed in July,she had been on z/d for allergies for several years.food and skin allergies. When she was diagnosed,we started her on w/d.she was on that until august 13th,actually only about 3 weeks. She was also on humilin n while on w/d. the vet thought dco had a better chance of regulation.. she get 5/8 cup a.m. and p.m.

She has not had any allergy problems since diagnosed!!
I believe her #'s last nite were that high because of the increased dose of insulin.she has not had #'s that high in quite awhile,3 weeks or more:(:(

Cebe 11-23-2012 05:43 PM

Re: Sissy's Mom
 
Wd should be good for allergies too, I would think. I used to feed z/d then switched to d/d, but it was all so expensive that I switched to California natural limited ingredient. This was before her diabetes. Just after her diagnosis I switched her to pinnacle.

I don't know much about dco. I think it's pretty well received here. But perhaps returning to w/d may help.

stylynjm 11-23-2012 06:08 PM

Re: Sissy's Mom
 
Yes,maybe.I am trying to stay focused and go slow.I will do the 6.5 units at nite and see how that goes. Then I would consider a food adjustment. Dco is supposed to work slower and help with regulation.it is 21% protein,46% carbs,& 10% fiber & fat.I have wondered about more protein,but will address that next!! Hopefully,she will start going lower with 6.5 .thanks:) yes,she did fine on w/d too.

stylynjm 11-24-2012 05:26 PM

Re: Sissy's Mom
 
Sissys today #'s r down to 150.I expect about 100-110 by supper.is it normal for dogs to run higher at nite,so would be safe with 6.5 p.m. unless her day #'s get to low???? Then could I cut daytime to 6 units instead of 6.25 in a.m. or cut back the p.m. back to 6.25???

Cebe 11-25-2012 08:39 AM

Re: Sissy's Mom
 
Not sure I would plan on all of the cutting. Hold steady or the numbers are gonna zing around again.

Knowing your dog, are you sure that the numbers will continue downward? I'm not, but I defer to your greater knowledge of how your dog trends.

Don't forget that you will also FEED your dog at the time of the next shot and that food will still need insulin to feed the cells. So, unless you go below 100, I might not change a thing.

Here's an anecdote from today: my dog has been running high since I switched and I'm trying to figure out how this stupid novolin works. This morning I overslept, and I tested Zoe before her shot: 245. That's her number 13-14 hrs post shot. I expected it to be higher. So it makes me wonder if novolin is a little slow in its action. But what that means is that -possibly- it just doesn't absorb as fast as humulin did. So what maybe happening with my dog is that she eats, gets her shot but the food digests for the first couple hrs and her numbers go up, then the insulin starts to absorb and the duration is longer than the 12 hours because it didn't really absorb for a little while. Something similar may be happening with sissy.

stylynjm 11-25-2012 09:53 AM

Re: Sissy's Mom
 
Makes sense. I started the 6.5 Thursday nite.here r her a.m. and p.m. readings so far:
Fri am. 437
Fri pm. 327
Sat am. 381
Sat pm. 240
This am. 268
She did rise before pm last nite,as u thought.
Her food is 21% protein.
46 % crabs
Is that a lot of carbs???

Will continue and see what happens.she seems to be lowest between 7-10 hrs.when is zoe low?

stylynjm 11-25-2012 10:15 AM

Re: Sissy's Mom
 
Makes sense. I started the 6.5 Thursday nite.here r her a.m. and p.m. readings so far:
Fri am. 437
Fri pm. 327
Sat am. 381
Sat pm. 240
This am. 268
She did rise before pm last nite,as u thought.
Her food is 21% protein.
46 % crabs
Is that a lot of carbs???

Will continue and see what happens.she seems to be lowest between 7-10 hrs.when is zoe low?

Cebe 11-25-2012 10:54 AM

Re: Sissy's Mom
 
I don't know when Zoe is low anymore. Her curve has changed a few times. For a while, she was low after 2 hours, just the opposite of sissy, the humulin she was on at that time would go straight to work and get ahead of her food. Then for a while she was flat. Now with novolin I don't know when her low point is. If my emerging theory about its duration is correct, her low is probably going to be much later. I need to do a proper curve soon.

stylynjm 11-25-2012 01:44 PM

Re: Sissy's Mom
 
IF Sissy goes to low this afternoon,70-90, would I be better to cut her nite dose back to 6.25 again or would I need to cut back to 6 units,I have 2 choices as I see it.cut her a.m. back to 6 units,and try to leave her nite at 6.5. , or go back to 6.25 a.m. and p.m.
any ideas about the carbs in her food,is that about right.

k9diabetes 11-25-2012 04:56 PM

Re: Sissy's Mom
 
I don't think anyone can say what amount of carbs is "right" - there are so many factors involved. If a dog absorbs insulin very quickly and tends to get a sharp drop in blood sugar, for example, that dog may need a higher than average amount of carbs to balance the jolt of insulin.

Your BG readings will tell you whether this amount of carbs works for Sissy.

The night time dose affects how high the blood sugar is starting in the morning, so they are naturally dependent on each other. So the decision has to be made in context... I can give you some examples.

If the blood sugar is high at breakfast, low in the afternoon, and high again by dinner time, that suggests a poor balance of food and insulin. You would have to lower the breakfast insulin to avoid future lows but probably won't have great blood sugar. In this case, if you cut the night time dose, the breakfast blood sugar would be higher still and I would, instead, reduce the breakfast dose.

If the blood sugar is low at breakfast and then goes lower still in the afternoon before rising at dinner time, then you would cut the night time insulin to raise up the morning level.

Any time you have a curve with a large difference in the highest and lowest blood sugar, you have food and insulin at odds with each other instead of working together and the only way to resolve that is to change things other than the insulin dose.

Try to just observe and react only to true problems, like blood sugar that's 90 or less and may still be dropping. It really helps to watch things work without any intervention whenever you can so you can see the big picture.

Natalie

stylynjm 11-25-2012 07:19 PM

Re: Sissy's Mom
 
Lol,I was dreaming..Sissy was 357 at supper.going to just stay with what I'm doing.she actually is kind of predictable.!! Lately anyway:)

stylynjm 11-25-2012 07:27 PM

Re: Sissy's Mom
 
Thank u Natalie. By highs u mean 300's and lows under 100????
Sissy is 200-300 in a.m. then low to mid 100's about 3-4 pm (lately) then 200-300's at supper.most days.

stylynjm 11-25-2012 07:31 PM

Re: Sissy's Mom
 
What is considered a large difference between highs and lows?/ more than 200????

jesse girl 11-25-2012 07:39 PM

Re: Sissy's Mom
 
i think 150 is very acceptable and 100 is very good for most

200 i dont think is terrible makes it more difficult to get better control with that much of a spread

it depends on the individual dog some dogs dont do well with big fluctuation and others it doesnt seem to bother my jesse it does affect her

its nice when numbers become more predictable at any level so you know what to expect

stylynjm 11-25-2012 08:19 PM

Re: Sissy's Mom
 
So how do u know when u need to make a food adjustment,and what to change??

stylynjm 11-25-2012 08:22 PM

Re: Sissy's Mom
 
Sissy seems to feel best between 150-250,give or take a little.

stylynjm 11-27-2012 11:41 AM

Re: Sissy's Mom
 
The tech at purina said doing whole foods vs processed could help slow sissys food down.any thoughts.(I am trying to put a picture from phone and send it to my thread, and post a chart of numbers.

stylynjm 11-27-2012 01:00 PM

Re: Sissy's Mom
 
I got a picture to my profile,why isn't it showing on my thread??


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