Angus the Westie

[tonyr]

Hi to all, this is my first post so be gentle with me to start with.
My reason for joining this site is because I want to learn how to do the best for my adored little Westie called Angus who has diabetes.

A little of his history and character.
He was born on 17/04/2006 and was neutered as a pup.
He has never been ill in his life, in fact he has been perfect with not so much as a runny poo.
He loves playing and barking at any animals he sees on the television and talks to himself constantly when watching, making all these strange noises.
He thinks he owns the place and all the land he can see, and everyone comments on how cute he looks.
He is my pride and joy.

[LizE]

Re: Angus the Westie

Welcome Angus!

He is a cutie - I have a soft spot for ground terriers. My dog Snickers was just diagnosed too so I'm in the same boat as you and have gotten a lot of great info off of this site. If it makes you feel any better my dog is adjusting to her new routine better than I am.

[CraigM]

Re: Angus the Westie

Welcome to you and Angus.

Tell us a little more about Angus. Weight, when diagnosed, insulin type, insulin dosage (starting and current), are you feeding / injecting twice a day about 12 hours apart?

Diabetes control takes time, but most can have relatively normal lives. My Annie is 14+ years old, and diabetic for 7+ years.

Craig

[tonyr]

Re: Angus the Westie

Now for the hard bit.
He was diagnosed in March 2015 after I queried the vet I had at the time why he was always drinking and peeing.
She done a few tests and said he had very high sugar levels in his blood and also high levels of ketones present.
He was kept in overnight to stabilise him and put on a drip.

On discharge she placed him on 7 units of Caninsulin twice dialy, showed me how to do it, and asked me to bring him back in a fortnight for testing .

I got home and read everything I could about dog diabetes. I also ordered online the Alphatrack 2 plus Vetpen and insulin cartridges, as I intended to do my own monitoring.

This appeared to stabilise him and the curves it produced looked good which I done every 4 weeks.
The vet seemed happy and said back in June that I should bring him in for a Fructosamine test every six months and do a curve every three months.

I done a curve in August which showed he had higher blood glucose than previously but not excessive, so I decided to wait for his Fructosamine test the following month and see what that showed.
After that Frustosamine test was done the vet asked me to repeat his curves again, and this is basically were it all seemed to all go sour.

The previous curves were all standard looking bowl shaped curves to begin with, which were now changing to flat lines.
Then the next lot of curves were now humped shape and his blood glucose was rising outside what was the safe level.
He was not exhibiting any symptoms though, ie thirsty or weeing a lot.
The vet thought it might be the Somogyi effect.

She instructed me to reduce his insulin to 5 units twice daily fom the previous seven twice daily and do another curve.
I done this and his blood glucose was even higher so she instructed me to change his insulin to 5 units once daily, and do another curve.
The next day he was now drinking and weeing heavily, and he would not eat, so I immediately checked his blood sugar which was 37 so I miissed the injection and called the vet.
She told me to try and get him to eat and go back to 5 units twice daily once he was eating properly. A few days later she asked me to come in for another Fructosamine test and to bring him in first thing with a full bladder, as she wished to test his urine direct from his bladder.
She also carried out further blood tests while I was there looking for other abnormalities which I imagine where to do with other endocrine disorders.

Anyhow, everything came back normal, this was just before Christmas, so she was now going to increase his insulin back to the original 7 units twice daily and I must do another curve.
This was done again and it showed a high glucose level with this strange hump shape, and the highest readings were inbetween injections, and the lowest just before feeding then injection ie:- 0900 and 2100.

He was increased to 8 units twice daily and another curve was done which was also high, with the strange hump shape.
Once again his dose was increased to 9 units twice daily and a curve done.
This time it was clearly too much, as his blood glucose had fallen too low just prior to injection.
I cannot go into half units with this vetpen size (1-16 iu) so 8.5 units is not an option, and the smaller vetpen (0.5-8 iu) is not an option.
The vet has now asked me to repeat this curve which i am going to do this Saturday, but I am not expecting anything different than before.

I would put up all his information if i could but the vet has eveything including my copies of the curves.
I do however have the figures from the last two.

All the curves are done before food and insulin is given in that order, also everything is exactly the same from diagnosis, for food, exercise length and time and and no treats are gven, at the moment, since the upset in August.

03/Jan/2016 On 8 units twice daily
Food and injection given at 0900 and 2100. Blood samples taken before food and injection
0900 274
1000 355
1100 345
1200 347
1300 390
1400 381
1500 384
1600 377
1730 419
1930 414
2100 282

18/Jan/2016 On 9 units twice daily

0900 90
1000 146
1100 175
1200 171
1300 217
1400 274
1500 249
1600 212
1700 189
1800 190
1930 111
2100 61

Can anyone make any sense of this ?.

[tonyr]

Re: Angus the Westie

ANGUS :- West Highland White Terrier D.O.B :-17/04/2006
DIAGNOSED :- 20/03/2015. Still not stabilised to date.
FOOD :- Burns Weight Control+ with 50 mg of Forthglade complimentary
wet food. Twice daily.
INSULIN :- On Caninsulin at currently 9 units. Twice daily with Vetpen.
METER :- Alphatrack 2 using their own strips
WEIGHT :- 10.65Kg

[MikeMurphy]

Re: Angus the Westie

Welcome and wow, that last hump shaped curve on 18 Jan looks like you a very close to the proper dose. It's too bad you can't go to 8.5 units. Most of us would probably prefer the hump curve because you don't have to worry about him going too low while you are away from home.

Hopefully others will chime in to recommend how to eliminate the lows at fasting.

[tonyr]

Re: Angus the Westie

I thought hump curves signify somethings wrong .
I have been telling the vet maybe we need to try a different insulin ie human.

[jesse girl]

Re: Angus the Westie

hi and welcome

what did a good curve look like on 7 units ?

the starting dose was a bit higher to start at 7 units and should have been more like 5 units but you were seeing good regulation and sometimes you get lucky ( i dont know anyone that got the dose write from the beginning )

could the dose have been a bit high at 7 units ? maybe and the body was able to still balance it out but kind of ran out of steam causing some instability

the one dose a day was probably a mistake if you going to reduce there needs to be 2 shots because normally insulin doesnt go past 12 hour duration . depending how long you were at 5 units twice a day may not give a complete evaluation at 5 units twice a day depending on how long you let it settle ( must remember if the dose was to much it may take some time to readjust )

you said they checked her over and everything is normal but do you see any different symptoms during the change in regulation many time its an infection as the culprit urinary tract ears and mouth those kind of things

you would think the 9 units is to much with the 61 . not absolutely positive the 5 units was not enough

the half unit adjustments maybe helpful but that appears not possible with how your injecting

best way to figure things is talking out loud and thats the best part about the forum . sometimes it can be simple

[CraigM]

Re: Angus the Westie

I agree with Mike that the a hump curve is often nice because you can generally not worry about him going too low during the day / night. My Annie has a hump curve. Text books show a bowl shape, but that isn't how many dogs react. You will read: "every dog / situation is different" frequently.

I'm thinking an easy thing to try is to give a tiny treat around 1930-2000 to prevent the very low reading at 2100?

Just to be sure your conversions from mmol to mg/dL is what we use, did you multiply your mmol reading by 18, use a conversion chart, or is your meter a U.S. version AlphaTrak?

Craig

[tonyr]

Re: Angus the Westie

hi and welcome

what did a good curve look like on 7 units ?

the starting dose was a bit higher to start at 7 units and should have been more like 5 units but you were seeing good regulation and sometimes you get lucky ( i dont know anyone that got the dose write from the beginning )

could the dose have been a bit high at 7 units ? maybe and the body was able to still balance it out but kind of ran out of steam causing some instability

the one dose a day was probably a mistake if you going to reduce there needs to be 2 shots because normally insulin doesnt go past 12 hour duration . depending how long you were at 5 units twice a day may not give a complete evaluation at 5 units twice a day depending on how long you let it settle ( must remember if the dose was to much it may take some time to readjust )

you said they checked her over and everything is normal but do you see any different symptoms during the change in regulation many time its an infection as the culprit urinary tract ears and mouth those kind of things

you would think the 9 units is to much with the 61 . not absolutely positive the 5 units was not enough

the half unit adjustments maybe helpful but that appears not possible with how your injecting

best way to figure things is talking out loud and thats the best part about the forum . sometimes it can be simple

The curves were looking in a good range up until August on the starting dose of 7 units twice daily then something changed.
I thought it might be because of a honeymoon period ie he was still producing some of his own insulin which has finally stopped.
I think he spent about 3 or 4 days on 5 units twice daily then his drinking started to increase which was getting worse and his glucose numbers were also a lot higher which was why the vet put him back to 7.
That was the onlty time he showed any symptoms.
She did say she thought after the 8 units curve I gave her that we might end up on 10 units twice daily.
He was checked thoroughly for ears teeth and gums swellings etc .

[amydunn19]

First of all, welcome to the forum!

I think he was started on a pretty high dose. Generally, vets start at 1/5 unit per pound. But, it appears 8 units was not quite enough from the curve. The good thing is it was relatively flat with no big swings.

The curve at 9 units looks like pretty decent control except the 61: might be tight in other places for some people to be comfortable. Remember, the real danger with diabetes is from low blood sugar. High blood sugar is not comfortable but not typically deadly. Hypoglycemia can be an emergency. Are you at home to monitor or does Angus stay by himself often? 9 is a bit much.

I would probably get away from the pen and switch to a vial of insulin and syringes. Many of us have to use half units so it really is best to have a means to adjust dosages. 8 1/2 units would be my recommendation.

Regarding the shape of curves, there is not really a right or wrong. Dogs are very individual, and it doesn't matter the shape as they process food and insulin differently. I would not try to force conformity because it might cause further issues. I would find that shape preferable for the reason Mike mentioned.

[tonyr]

Re: Angus the Westie

I agree with Mike that the a hump curve is often nice because you can generally not worry about him going too low during the day / night. My Annie has a hump curve. Text books show a bowl shape, but that isn't how many dogs react. You will read: "every dog / situation is different" frequently.

I'm thinking an easy thing to try is to give a tiny treat around 1930-2000 to prevent the very low reading at 2100?

Just to be sure your conversions from mmol to mg/dL is what we use, did you multiply your mmol reading by 18, use a conversion chart, or is your meter a U.S. version AlphaTrak?

Craig

My meter is a U.S one, I have to divide by 18 before I give the chart to the vet.
I was going to give some more wet food maybe 25mg of what he currently has in the evening around 6pm, but its the morning one I worry about .
I have changed vets since the August episode because she said we must start bowel scans which I disagreed with as I thought they are trying to milk me for more money.
She even said we should put him on a perscription diet (Hills WD) which is for weight loss, and he was already losing weight .
Both vets now have said the hump curve is wrong .
Also they both said they have not seen many diabeteic dogs which worries me.

[tonyr]

Re: Angus the Westie

First of all, welcome to the forum!

I think he was started on a pretty high dose. Generally, vets start at 1/5 unit per pound. But, it appears 8 units was not quite enough from the curve. The good thing is it was relatively flat with no big swings.

The curve at 9 units looks like pretty decent control except the 61: might be tight in other places for some people to be comfortable. Remember, the real danger with diabetes is from low blood sugar. High blood sugar is not comfortable but not typically deadly. Hypoglycemia can be an emergency. Are you at home to monitor or does Angus stay by himself often? 9 is a bit much.

I would probably get away from the pen and switch to a vial of insulin and syringes. Many of us have to use half units so it really is best to have a means to adjust dosages. 8 1/2 units would be my recommendation.

Regarding the shape of curves, there is not really a right or wrong. Dogs are very individual, and it doesn't matter the shape as they process food and insulin differently. I would not try to force conformity because it might cause further issues. I would find that shape preferable for the reason Mike mentioned.

The first vet said in March you are lucky we caught him early as his eyes are perfect. Then in August she said I can now see he his developing cataracts but dont worry because he will be fine.
I replied he might be fine but I wont be, it would break my heart.
Then this new vet who I am now with said he could not see any signs of cataracts, I do not trust any of them to be honest.
I am at home with him as I am now retired, but the thing is with us here in the U.K is we must get a prescription from the vet to get our insulin, we cannot go to walmart and buy it, so I am at their mercy.
I have just had a prescription fulfilled which should last me about 4 months.

[jesse girl]

Re: Angus the Westie

ok so 5 units may not be enough

your thought of a honeymoon period is very plausible . usually what you may see with that is very good regulation with extremely stable blood sugar maybe less than 25 points from low to high for the day in that 100 range . something you may see with normal sugar ( which is quite rare )

you have crossed off medical reasons as far as you know. you have an understanding of a dose thats not enough and maybe a dose thats to much that 61 does not give an opportunity to raise the dose until thatis brought up ( we base a dose adjustment on the lowest number in a curve )

what i believe what happens when you loose the natural process of insulin counterbalancing sugar on demand to injected insulin that is time released can make things a bit more unstable because each process is so different and the body has to adapt to the new reality of injected insulin

regulation may not be as good as you have seen and that maybe the new reality. the good thing it doesn't have to be .many caretakers are very happy with a level from 150 t0 250 and some dont even have it that good and still do fine just to give some perspective on the matter

[tonyr]

Re: Angus the Westie

ok so 5 units may not be enough

your thought of a honeymoon period is very plausible . usually what you may see with that is very good regulation with extremely stable blood sugar maybe less than 25 points from low to high for the day in that 100 range . something you may see with normal sugar ( which is quite rare )

you have crossed off medical reasons as far as you know. you have an understanding of a dose thats not enough and maybe a dose thats to much that 61 does not give an opportunity to raise the dose until thatis brought up ( we base a dose adjustment on the lowest number in a curve )

what i believe what happens when you loose the natural process of insulin counterbalancing sugar on demand to injected insulin that is time released can make things a bit more unstable because each process is so different and the body has to adapt to the new reality of injected insulin

regulation may not be as good as you have seen and that maybe the new reality. the good thing it doesn't have to be .many caretakers are very happy with a level from 150 t0 250 and some dont even have it that good and still do fine just to give some perspective on the matter

Thank you everyone that has replied and I am on a steep learning curve I know.
Now that nobody has faulted a hump curve then that is a relief, contrary to what the both vets have said to me.
When I was looking for the second vet, one practice I visited were horrified that I wanted to home test.
When i enquired what there prices would be it came to nearly £200, this is about 280 dollars, and considering I think I have done 9 or 10 curves plus all previous expense since March of £1200 for tests, insulin, eqpt etc, its extortion.
So if I do not have to change insulin to a human type, and there is no other complication, then I have further options.
1. Try to change diet to give a longer effect on the insulin .
2. Try change to 3 meals per day whilst injecting twice daily, ie: 8am, 4pm and midnight if feasible.
I can control things during the daytime and observe him and monitor, its early morning before 9am that concerns me.
Have I got it in perspective ?