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Old 03-07-2018, 02:43 PM
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hybridtheory45 hybridtheory45 is offline
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Default Sasha's puzzling curve

Hello everyone! Some back story before my question:

My dog Sasha (lab, 74ish pounds, 11.5 years old) was diagnosed with diabetes last month after a collapse scare at home. She had been very lethargic suddenly and coughing a lot, and at 11pm one night, she got really wobbly and collapsed into her water bowl, so we rushed her to the animal ER. They found diabetes, high blood pressure, and 2 masses in her lungs. She had also recently been diagnosed with laryngeal paralysis. (whew!)

In any case, she was started on Vetsulin at the hospital (24 units 2x a day, as her glucose wasn't responding to less, and we took her home after a few days. We took her in for a curve at our regular vet a week later, and she was only at 100 about 20 minutes after eating, so while they kept her all day and did the curve, they gave NO insulin, and recommended we drop to 20 units 2x a day.

The next day Sasha had a CT scan for her lungs, which required fasting, and they said to give half her usual dose, so 10 units. (I now realize that was too much for her fasted, but trusted them.) Unsurprisingly, she was at 58 prior to her scan, so they gave her some fluids and sorted her prior to anesthetic, then recommended going even further down to 15 units. This seemed like WAY too low to me, so I met both vets in the middle and settled on 17 units. It should be noted that her cough went away as her blood sugars regulated. No idea why.

We took Sasha back to the vet a week later for another curve at 17 units, and though she never dropped below 160, her high was in the mid 300s. They elected to stay at 17 units 2x per day.

This past week we got our own home meter so we can monitor ourselves, and I ran my own curve Sunday because I noticed she had been drinking a lot more and her cough was returning, which I've quickly noticed means her sugars are high. Here are the odd results of the curve:

7am (fasting and pre-insulin): 277
9am: 451
11am: 394
1pm: 452
3pm: 349
5pm: 363
7pm (right before feeding and insulin): 396
9pm: 374

This is really puzzling to me, as she never really curved at all, nor dropped below 349 except for the early morning fasted reading. I've done spot check 2x daily since Sunday when I ran this, and her glucose is steadily rising...this morning her fasted/pre-insulin was 518, which is what it was when she collapsed at the beginning of this adventure. The vet has advised me to go up to 19 units per day, but I'm starting to suspect a bad bottle of insulin and am picking up a new one on my way home today. These higher readings seem to coincide with starting a new bottle that we had shipped to us instead of picking it up.

Does anyone have any other thoughts on what could be going on? Thanks in advance!!
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Old 03-07-2018, 03:35 PM
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CraigM CraigM is offline
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Default Re: Sasha's puzzling curve

Welcome to the forum.

What meter did you get?

I’d think bad insulin is unlikely, unless it was sitting in hot storage. Just making sure you are well mixing the Vetsulin? I don’t recall the exact wording / instructions on the data sheet, but you are supposed to roll or gently shake (emphasis on “gently”) until thoroughly mixed.

I also like to ensure folks that are using Vetsulin are using U-40 syringes, usually only purchased from a vet clinic.

Craig
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Annie was an 18 pound Lhasa Apso that crossed the rainbow bridge on 10-5-17. She was nearly 17 years old and diabetic for 9½ years.
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Old 03-07-2018, 03:40 PM
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MikeMurphy MikeMurphy is offline
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Default Re: Sasha's puzzling curve

Hi and welcome to the forum.

Thanks for the background on Sasha. That’s very helpful.

Your recent curve looks pretty flat and would normally require a one unit increase, followed by another curve after one week. However, it wouldn’t hurt to stay at the current dose using the new vial.

Keep us updated on her progress.
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Lily is a 62 lb English Setter, born 07-27-2007.
Diabetes: Aug 2013 - Hypothyroidism: Dec 2013 - Cataract Surgery: Feb 2014
Insulin: Novolin R/N mix - Meter: ReliOn Prime
Nulo Adult Trim Cod & Lentils, Pumpkin, FortiFlora, Dasuquin, Thyroxine
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Old 03-07-2018, 04:04 PM
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hybridtheory45 hybridtheory45 is offline
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Default Re: Sasha's puzzling curve

Quote:
Originally Posted by CraigM View Post
Welcome to the forum.

What meter did you get?

I’d think bad insulin is unlikely, unless it was sitting in hot storage. Just making sure you are well mixing the Vetsulin? I don’t recall the exact wording / instructions on the data sheet, but you are supposed to roll or gently shake (emphasis on “gently”) until thoroughly mixed.

I also like to ensure folks that are using Vetsulin are using U-40 syringes, usually only purchased from a vet clinic.

Craig
We got the AlphaTrack meter. I even tested with the control solution after some higher readings just to make sure because I was surprised. She's been pretty well controlled since the fasting dose snafu.

The animal hospital made sure we definitely knew how to mix the insulin...in fact I'm the only one who does it because I don't necessarily trust my husband to do it the right way and I'm rather obsessive about getting it right. hah! We've been through several bottles already since she gets so much (I think this is our 4th bottle) and are still on the box of U-40 syringes we originally got from the vet.

In any case, she got 19 units this morning; will test this evening when I get home from work. Mid-day dog walker that lets her out to potty said there was more water gone that usual from her bowl, so I know she's still somewhat high.

Last edited by hybridtheory45; 03-07-2018 at 04:11 PM.
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Old 03-07-2018, 04:13 PM
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hybridtheory45 hybridtheory45 is offline
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Default Re: Sasha's puzzling curve

Quote:
Originally Posted by MikeMurphy View Post
Hi and welcome to the forum.

Thanks for the background on Sasha. That’s very helpful.

Your recent curve looks pretty flat and would normally require a one unit increase, followed by another curve after one week. However, it wouldn’t hurt to stay at the current dose using the new vial.

Keep us updated on her progress.
Thank you! At this point my main concern is to get her numbers down since she's getting into her previous hospitalization territory, which makes me nervous. Of course going too low has its own scary issues!

What a fine balance we walk with our sweet pups!
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Old 03-08-2018, 06:23 AM
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Raysaint Raysaint is offline
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Default Re: Sasha's puzzling curve

Remember it takes a while to regulate, so only one month in, those numbers aren't too bad. Numbers aren't high enough in my opinion to cause hospitalization.
One thing you can't do is rush it. A one unit increase is best, for a week at least and then a curve. Don't be jumping around to all different doses.

Stay consistent and methodical. Give it another month and see what progress you're making. Spot check nadir times.
The early stages can be crazy with different numbers and patterns, as the body adjusts to so many new things going on.
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Riley, 8 yr. old maltipoo, 25 lbs., diagnosed Feb 2017, taking thyroid meds, had pancreatitis and DKA mid March, eating Wellness Senior formula can food. NPH dosage now at 9.0 units Humulin N. Adding either pumpkin, spinach, blueberries, yams, or green beans to his food. Also omega-3 oil.
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Old 03-09-2018, 09:54 AM
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hybridtheory45 hybridtheory45 is offline
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Default Re: Sasha's puzzling curve

Sasha's levels are slowly coming back down with the 19 units. Her fasting this morning was 281, which is a HUGE improvement from the 500s the other day. She's much perkier and has stopped coughing as well, now that she's back down, which is a relief.

I've been reading old posts on this forum religiously and soaking in all the information I can - what an amazing resource for newbies like me!

I do have one question I'm hoping someone can answer - how do you all handle the time change coming up this weekend? Keep going by the clock? Adjust by 30 minutes for a day?
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Old 03-09-2018, 10:16 AM
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jesse girl jesse girl is offline
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Default Re: Sasha's puzzling curve

Quote:
Originally Posted by hybridtheory45 View Post
Sasha's levels are slowly coming back down with the 19 units. Her fasting this morning was 281, which is a HUGE improvement from the 500s the other day. She's much perkier and has stopped coughing as well, now that she's back down, which is a relief.

I've been reading old posts on this forum religiously and soaking in all the information I can - what an amazing resource for newbies like me!

I do have one question I'm hoping someone can answer - how do you all handle the time change coming up this weekend? Keep going by the clock? Adjust by 30 minutes for a day?
It depends on you and your situation . I just do a 30 minute change so in the morning i feed her at 7 am . After the time change i will give her shot at
7: 30 am

If you got really good regulation and any small change could disrupt that you may want to be more precise in your methodology

Glad things seem to be improving
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Jesse-26 lbs - 16 years old ,10.5 years diabetic, one meal a day homemade and a vitabone snack . 3 shots of Novolin a day . Total insulin for a 24 hour period is 6.5 units of NPH insulin .
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Old 03-09-2018, 12:54 PM
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hybridtheory45 hybridtheory45 is offline
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Default Re: Sasha's puzzling curve

Very helpful, thank you! Sasha is 7am as well, so I think I'll follow your lead and do 7:30 that morning.
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