Having Trouble Getting Simon's Glucose down

[Simon]

I have an 8 year old mini daschund, Simon. He was diagnosed with Diabetes 2 months ago. The Vet started him out on 2 units of Humulin nph twice a day...he goes to the vet every Monday at 1pm to get his blood taken...gradually increased to 5 units, and the lowest his glucose got was 320 after 5 weeks.

Last week the Vet switched him to Vetsulin at 2 units, this week 3 units and his Glucose was 492.

He has steadily lost weight from 12.4 and now weighs 10 lbs (11 weeks).

His diet is:

2 meals (half before the shot and half after) 6oz boneless chicken breast and 3 table spoons of whole grain brown rice

He also at times (when hungry, always left out) his diabetic food Purina DCO as a snack.

Also at times we've given him whole grain lavish as a snack when he's ravenous to tide him over.

He still drinks 2 cups of water a day and still excessively urinates, to the point he wakes up every two hours during our sleep.

Based on the above, can anyone spot anything that might be affecting his glucose coming down? we're not sure whether he should get a second opinion, but were especially worried when after his glucose steadily came down on humulin (but not below 320) it shot back up so high on Vetsulin.
Any help is greatly appreciated by myself, and Simon! THANK YOU

[We Hope]

Re: Having Trouble Getting Simon's Glucose down

Welcome!

Am first going to ask if there's any reason why you're feeding half the food before the shot and half after?

What you hope to do with any insulin is to try to get the food and the insulin to the "finish" line at the same time. You want the insulin to be starting to work at the time the food is beginning to be digested. When you don't have the timing right, this affects the action of the insulin and it isn't able to do what it's meant to.

When you're not giving meals on a schedule, this can affect the action of the insulin. The most common feeding pattern is to give the day's amount of food divided into two equal portions, which come 12 hours apart before the insulin shots.

Having free feeding and "extras" between meals can affect what the insulin does or doesn't do. What happens to people when they eat at a time when they don't have enough insulin to cover that food is higher blood glucose. Part of what the insulin dose is based on is the amount of food intake for that day; when there's more food than the insulin can properly handle, the result will be higher bg's. When people with diabetes eat more than they'd planned their insulin to deal with, they have higher blood glucose from it also.

Some people feed on a 3 or 4 meal a day (day's food divided into these segments) plan to either correct a problem (going too low at some point in the day, taming post meal spikes) or because there's another medical condition like pancreatitis which sometimes needs smaller, more frequent meals.

Have other medical conditions which would tend to keep the blood glucose higher, such as Cushing's, been ruled out with Simon? What was the reason for the change of insulin?

Please tell us more about Simon!

Kathy

[peggy0]

Re: Having Trouble Getting Simon's Glucose down

HI and welcome. There are several experienced folks who can help you out here. I've been doing this for about 4 months now and still in the learning mode. Is he getting 3 units twice a day or once? Does he get the shot with his meal? Are you thinking about monitoring him from home which is a huge help in determining what's going on with your pup. Free feeding him will not help get him regulated, nor will the snacks. Some dogs blood glucose rises with chicken and/ or rice. Why are you not just feeding him the DCO?

He really should have as much water as he needs at this point. You need to make sure his kidneys aren't being affected by the highs. Are you monitoring his ketones with urine strips?

I think if you can answer these questions, you'll get some advise.

[Simon]

Re: Having Trouble Getting Simon's Glucose down

I give Simon half of food right before and shot and half right after as a treat. He stopped eating Purina DCO two weeks ago and so I started boiling boneless chicken breasts for him, like I previously did four years ago when he was hospitalized with pancreatitis. I leave the DCO food in h is bowl but he does not touch it. I was reading about Cushing's. I cannot give him the shot without him eating and he will not eat the DCO. How is Cushing's treated? -Thank you so miuch.

[Simon]

Re: Having Trouble Getting Simon's Glucose down

Simon gets 3 units of Vetsulin twice a day. Fresh water is always available. I will purchase urine strips tomorrow morning. He does not eat between meals. He just eats boneless breast with whole graiin brown rice. Stopped eating the DCO, but frankly his blood glucose was not lower when he was eating it. Thank you so much. I really appreciate your advise.

[We Hope]

Re: Having Trouble Getting Simon's Glucose down

There's more than one form of Cushing's, so there's more than one way of treating it. The treatment would depend on the form. There's typical and atypical, pituitary or adrenal.

http://www.caninecushings.net/forums/

This is our sister board and their focus is Cushing's; you might want to do a little reading there.

Has Simon been checked for infections, such as UTI? Diabetics are more prone to infections than non-diabetics and often the infections can be subclinical, or "hidden", meaning that the only sign you might have that they are there would be higher than normal (and possibly lower than normal) blood glucose. There are times when it's necessary to do cultures to determine if there is truly an infection and if so, what the best antibiotic for treatment of it is.

[NancyB]

Re: Having Trouble Getting Simon's Glucose down

Hi and welcome. I'm new here, too--for just a couple of weeks. There are great people and information here, so I hope you will find the help you need.

You mentioned that you take Simon in every week at the same time and it sounded like they do one blood glucose check. How often have they done a "curve" where he gets tested every couple of hours all day? Often there can be fairly wide swings from high to low and it's important to get the big picture related to food and insulin dosing.

Also, we found that our dog, Milo, had higher values at the vet due to stress. Apparently, dogs can go either up or down in response to stress or exercise. It does sound like Simon is still high though, if he's drinking and peeing a lot.

You mentioned a second opinion and if you are having that thought I would go with it. It does sound like you aren't being given all the support you need and especially if they are not monitoring more regularly it might help to have someone take a second look.

Doing the testing at home has been the best thing for us and it's much easier than I thought. The sooner you get him regulated the better.

Best of luck to you and Simon,
Nancy

[eyelostit]

Re: Having Trouble Getting Simon's Glucose down

Hi and Welcome to the board !

I wondered too if your vet is doing a curve every 2 hours or just taking one blood sample.

If you can home test you can do this yourself and you will have a picture of how Simons body is processing his food and insulin.

Hope this helps & hang in there

dolly

[BaileyBear]

Re: Having Trouble Getting Simon's Glucose down

Hello - welcome to you and Simon.

Sounds like you may be dealing with a vet who is not providing you all the information you need. Testing Simon at the same time once a day isn't going to give you much information. In fact, if that 1pm test is within a few hours of his morning meal, it may be his highest reading of the day. A curve gives you a better picture of how the blood glucose is responding to Simon's food intake, insulin dose, and his activity. If he has had a curve at the vet, they usually keep them there all day and test them at least every 2 hours. Has he ever had one done?

You can purchase a blood glucose monitor from any pharmacy and learn to test Simon at home, which will also eliminate any possible large increases or decreases in his numbers due to the stress or excitement of going to the vet...not to mention save you a lot of money instead of having curves performed at the vets. My dog gets very excited about the vet (he loves going) and all that excitement drops his BGs as much as 100 points. But some dogs have an increase in their numbers from excitement/stress. There are some videos on the site that show different methods and places to test.

The DCO may or may not help bring Simon's numbers down. My dog will eat anything, but some dogs who won't can be enticed to eat the dry by adding moist, flavorful items to their food. Low fat, no sodium chicken broth is often mentioned and my brother has a lot of success getting his picky eater (diabetes/cushings/colitis) to woof it down. I was previously adding chicken to my dogs food to bring down post meal BG spikes he is also on DCO), but it made his overall numbers higher. I tried adding scrambled egg and that did the trick. You could also try cutting the chicken into the tiniest of pieces and mixing it in with the food well so that he hopefully takes in the dry with the chicken. I do the same thing with Bailey's eggs so that he doesn't just eat the egg off the top first, lol.

An underlying infection can definitely mess up a dogs BG levels. My dog had an ear infection for a while and it sent his numbers back into the 500's. Less than 2 days on his antibiotic and his numbers came back down.

It sounds like there can be a lot of possibilities going on - maybe more than one. But the more information you can provide, the more help the very experienced members can give. My dog Bailey was just diagnosed in January, but there are many people on this board who have been dealing with a diabetic dog for years and they are so generous with their time and information. You're in the right place and they will help guide you through the process of deciphering what's going on with Simon.

[k9diabetes]

Re: Having Trouble Getting Simon's Glucose down

Welcome to you and Simon!!

I definitely recommend a curve for Simon as a spot check at the same time every day doesn't tell you much.

Even spot checks at various times of day would be more helpful because you would get a fuller picture of the balance of Simon's food and insulin throughout the day.

For a long time we fed our dog nothing but chicken, white rice, and low fat cottage cheese in equal quantities. The cottage cheese helped level out his blood sugar during the day as it was digested fairly slowly by our dog.

The thing is... literally, every dog is different. So what works for Spot might work for Bowser but not for Simon or Fido. So what you need more than anything is information specific to what works and doesn't work for Simon.

I'm also curious why the insulin was changed at 5 units of NPH. Could be that Simon simply needs more than the average amount.

Simon could go to 10-12 units of insulin and still be considered a normal diabetic dog who just needs a dose on the high side. This often seems to be true with high energy dogs. We have a couple of members here who have small terriers and they have sometimes needed something like 21 units of insulin in a 24 pound dog BUT got excellent regulation when they went to that higher dose.

The weight loss may be a combination of not enough insulin and not enough calories. Might want to up the quantity of food while you are regulating him too.

So he no longer gets DCO left out for him?

Checking for infections is also very important, though I suspect that since he's never been below 300 that he simply needs more insulin than he's been given.

Whether Vetsulin or NPH, my first approach would be to not be afraid to exceed 5 units of insulin per injection. I wouldn't worry until you reach 10-12 units per injection and you still don't see blood sugar below 300. At which point Cushings would be one consideration.

And then I would monitor his blood sugar more thoroughly with a curve, either at the vet or learn to do it at home, to see how well his insulin and food are working together.

A second opinion is always a good idea. And if your vet is unwilling to more aggressively work to regulate Simon, you need a vet who will work with you to do this. Unfortunately, it's not all that unusual to have change vets when diabetes comes along.

Doxies are notoriously difficult to home test blood glucose... how is he with his insulin injections? Do you think you could test his blood sugar at home?

I have no doubt that Simon can be better regulated. Just will take a more aggressive, flexible approach than it seems you have gotten from the vet so far.

Natalie

[k9diabetes]

Re: Having Trouble Getting Simon's Glucose down

Just checking in on Simon!

Natalie

[malencid]

Re: Having Trouble Getting Simon's Glucose down

Please read my post about Buck. To control Simon's diabetes you are going to have to learn how to do blood tests. If you have any questions the people on this forum will usually have an answer.

[Simon]

Re: Having Trouble Getting Simon's Glucose down

Thank you all for your advice, it's very appreciated.

Update on Simon:

Last Friday Simon's glucose level was 320, which was encouraging from the 490 the week before. His Vetsulin was increased 3.5 units. Today he went again for blood work and today his gl was 420...the vet tech mentioned that she thought simon was so extremely nervous, this could be why his blood sugar was so high. The Dr. increased his vetsulin to 4 units today.

He weight today was 9lbs, 6 ounces. The Dr. said it was very important that we get Simon to eat his DCO along with the chicken and rice, that he's just not getting enough calories. So we're mixing sodium fat free colle ginn chicken broth over his DCO, and let sit until it gets soft, mixed with whole grain brown rice and chicken. He ate a little bit of it, but still won't eat all of the DCO.

[We Hope]

Re: Having Trouble Getting Simon's Glucose down

Glad to hear that Simon's doing better!

Like people with diabetes, dogs can have their bg's go high or go low in response to stress or excitement. We have a poll going here:

http://k9diabetes.com/forum/showthread.php?t=649

with the majority of those voting saying their dogs tend to go low in response to stress/excitement.

I would keep an eye on Simon for any possible lows since you suspect that his bg's go higher in response to stress (being at the vet) and he's had his insulin increased. While I don't think you're going to have any problems with the increase, it's good to keep an eye since Simon's bg's in "reality" (at home) are probably lower as long as he seems to go higher at stress times.

It may take you a little time to get Simon more interested in that DCO. What you're doing with the chicken broth is a good idea; the few times I needed it, I always used low-sodium, fat-free also.

Sounds like things look a LOT better for Simon!

Kathy

[k9diabetes]

Re: Having Trouble Getting Simon's Glucose down

I see you were gonna purchase some urine strips - have you started monitoring him with those at home? If so, what have the results been like?

Natalie