Winston - Odd numbers; need advice

[Daisydog10]

Re: Spoke too soon, need advice

When she was on the Vetsulin, I went up a half unit at a time for 5 days to let her settle in, then did a curve. Daisy was in the 300's, then 400's, then her highest level was 687. I panicked. Her swings were 650, down to 325, then up to 687, then back down to 350 in a 12 hour period. I'd up the dose, I'd lower it, nothing worked and I thought she was either resistant or was rebounding. I changed her food to a low glycemic homemade diabetic dog food and found she stabilized a little and her numbers came down but they were still up in the 400's. I took her curves to the vet and she suggested the insulin was not a good match, let's try Novolin N and to start her on 3 units. The vet did like the homemade diabetic dog food as it was low glycemic, but she did tell me to add an adult centrum vitamin for every 4 cups. I also added a little cinnamon and chromium picolinate as it stabilizes blood sugar in humans, so I asked the vet and she said yes, give it a try. So after 2 months we were just starting to get on the right road. I could see by the curves that she was processing the Novolin N much differently than the Vetsulin, more like a normal curve and this combination was eventually going to work for her.

With much advice from the forum members, I eventually upped her from 3 to 5u using 1/2 unit increments and I could see her numbers drop. 4.5 wasn't quite enough and 5 was just a little too much and the curve wasn't flattening out. The members here told me to sit tight and give it a while and sure enough, her curve flattened out nicely. Just a little under 5u put her at 98-136 lows and around 185-225 for the highs. She would eat worms, lizards and have feathers hanging out of her mouth and she'd go up a little, but by morning she was right back on target.

Then I got a new vial. She tanked on me last night and we were up eating at 9p and 11p until her BG came back up and I dropped her dose to 4.5 this morning, came home from work at 11a and checked her, gave her a couple baby carrots and some homemade diabetic dog food and she was 247 this evening. I dropped her back to 4 units tonight and we'll see where we're at in the morning.

This is some scary stuff and I understand exactly what you're going through. I cried. I was so afraid Daisy was going to die or go blind before I could get her somewhat stabilized and I was a mess. The members here calmed me down and told me to breathe, we'll get this.

It's finding the right combination for Winston and what he responds to. The more I read, the more I realize that it's a crapshoot because each dog is different and it could be the food, could be the insulin, could of passed the correct dose. But one thing I did notice was the curves can give you some nice clues as to what may be happening and the members on this forum can almost pinpoint what's going on. More so than some vets.

Keeping Winston in my prayers that he gets regulated quickly. You'll get there just like we did.

[amydunn19]

Re: Spoke too soon, need advice

I would caution you not to assume lowering carbs will flatten the curve or he would need less insulin. Carbs are necessary and it is helpful to keep in mind that not all carbs are created equal. Many have found eliminating or subtracting too many carbs gave the opposite results. The dog may have an immediate drop that seems to be effective - the insulin is very active at first without carbs to slow it down, then the insulin is gone too quickly and blood sugar starts to rise and there is nothing to make it go down. So you end up with a dramatic drop then a dramatic rise. I always played around with food but I had to be careful not to draw a conclusion that wasn't really there. Also, when you feed more protein, it can be a much higher fat ratio. Since pancreatitis is such a risk for diabetics, you want to make sure that you aren't feeding too much fat.

I wouldn't say diabetes is a crap shoot - it is a matter of figuring out what works for your dog. You can learn what has worked for others here but it may not work for you. I found that I had to be willing to take a chance and try something different and evaluate it over a period of time. Working full time may be a challenge but hopefully, you will get a summer break and be able to work on this during that time. I fed Maggie four times a day and it worked best for her and only two of those meals were alike. But, it took a lot of testing and keeping track of everything.

[Aggie]

Re: Spoke too soon, need advice

OK, his food currently is Wellness Reduced Fat kibble (low fat, low carb), with a quarter can of canned food mixed in, per meal. I was using canned Simply Nourish chicken stew (low in fat/carbs) for this. This has been his diet for most of the time he has been diabetic. The kibble is 440 calories per day, the canned food 150 per day.

Winston thrives on novelty, and so he started to get picky about breakfast as he has his whole life. It was inevitable. Also I think as his numbers dropped, he stopped being so hungry.

Because of what we went through on Sunday after he refused breakfast, i bought a new wet food which seems to be pretty low in fat and carbs, keeping the Wellness as the dry. So far Winston loves the new food topper a lot.

In a few weeks or months, he may not.

Bought a couple of different flavors to see if that will keep his interest up. I know it's better and easier to regulate by always using the same food, but I have to balance that against his getting something he will eat.

Regarding the Vetsulin, it's been slow but with some progress. He started with numbers high 400s-600s at 4 units, and at 7.2 units he had dropped to mostly 300s (although, it's likely that there were 400s at the beginning and end). So after raising briefly to 8 units, but then seeing that high fasting in the 600s and a low of 199, we are now backing down and trying 7.6 for a week or so. I maybe shouldn't have tested so soon after the 8 units... it was only a day or so we'd been on that. Maybe the curve would have flattened in a week.

I'm willing to wait a bit to see what the 7.6 does. My guess is that it will not be enough. However, he is drinking less now. Normal would be a bowl a day, high numbers were two bowls a day, and right now it's about 1.5 bowls. (a bowl being 16 ounces, and Winston at 21.5 pounds). So that's kind of good.

[Aggie]

Re: Spoke too soon, need advice

Doing a curve today, with a fasting blood glucose (FBG is something which I very rarely have done so far). It was 189! I was shocked. Maybe 7.6 units is enough. Amazing to me that 7.2 can be obviously insufficient, and 8.0 may have been too high, causing a rebound sort of thing. I am going to continue to take readings today to see how the 7.6 works throughout the day.

At the very least I would say we are getting close to correct.

[Raysaint]

Re: Spoke too soon, need advice

What I've learned thru my first 2 months with my dog, and what most vets will tell you, any change in dose, you need to give it a week for the body to adjust and give you a true picture of how it will process that amount. I've found that any dose change, his body seems to react untypically at first. Big drops in BG or unexpected numbers at certain points in the day, and you think you've hit on the perfect dose. But your expectations the next day are met with surprise, and you'll wonder why, and maybe be tempted to change the dose again.
Please be methodical in changing the dose. I learned the hard way. It's taken me longer than it should to regulate my dog, and I'm still not there.

[Daisydog10]

Re: Spoke too soon, need advice

It was 189! I was shocked.

That's great!! You're getting there!!

[Aggie]

Re: Spoke too soon, need advice

The results of the curve on 7.6 units vetsulin (twice a day). I think we are closing in on regulation.

6 AM fasting 182. Fed right away after seeing this rather low number, and waited a half hour to make sure blood sugar went up over 200.

6:30 AM 338. Apparently waiting a half hour to give insulin after feeding was unnecessary and may have caused higher readings this morning.

9:45 AM 374
12 noon 274
1:15 PM 157 (low)
2:00 PM 211
4 PM 258
May take one more reading at 5:30 or 6, before dinner.

So, what do you all think? I feel like I can't add more insulin because the low reading is 157 and I'm not sure much lower is a good idea. However, I'd like to flatten the curve somehow. Although, as I said, I waited a half hour to give insulin after breakfast, maybe if I gave insulin earlier the curve wouldn't have gone to the upper 300s (?). Should I just stay the course and keep giving 7.6 units? The curve as it stands has a bigger swing than I'd like. But, overall, this is way better than it's ever been before.

By the way, it has been 8 days since the last curve. I bumped up to 7.6 last Thursday with the intention of going up to 8.0 Friday night, which I did. But after a rocky bouncy Saturday and refusal of food on Sunday, I dropped it back to 7.6 Sunday night. Raysaint, I don't think 2 months is at all unusual for regulation. It's been over 2.5 months for us and I think I've been pretty methodical, overall, waiting a week to 10 days between increases.

[Daisydog10]

Re: Spoke too soon, need advice

I'd leave him there for a while and like the others told me, let him settle in on this dose for a little longer and see.

Daisy's curve didn't flatten out right away and Jessegirl told me to hang on, sometimes it will on it's own and sure enough.....

Looking good!

[Aggie]

Re: Spoke too soon, need advice

Thank you!. What I'm wondering is if his fasting was 182, then how low did he go overnight? Usually his fasting would be considerably higher than his low point. Should I be concerned about that?

[jesse girl]

Re: Spoke too soon, need advice

if your concerned you can take some tests latter in the night . there was many times during jesses regulation process i tested at midnight and sometimes latter

sleep was a premium back in those days but i sill remain a light sleeper from the experience

curve looks pretty good as daisy suggested maybe give it a bit more time to settle then do another curve

job well done

[Aggie]

Re: Spoke too soon, need advice

After his 4:00 reading of 258, 90 minutes later at 5:30 he suddenly spiked over 400. So his fasting this morning was 182 and his fasting this evening is over 400. I don't understand how that could even happen. I just fed him now and gave him his evening injection with the same 7.6 units.

For sure we aren't going to move the insulin right now. Another week at least to see what happens.

Winston and I actually go to bed at 9:30 and lights are out before 10. I know, weird. But I have to get up early on school days, at 5:45 AM and I am no good teaching if I don't get sleep. If anyone was going to test him at midnight it would have to be my night owl husband. But so far, he hasn't even done an injection, sigh. Although he helps me give injections by feeding the pup treats.

[jesse girl]

Re: Spoke too soon, need advice

not good for teachers to be tired

you might have to talk to craig on how he became the primary caregiver to his Annie and like your husband he wasn't that involved in the beginning

those are the things that still drives me crazy when things look good and suddenly they dont and it happens so quickly

that is the burden of testing knowing how inconsistent numbers can be even though consistency his held tight . just showing how difficult it is to mimic such a delicate balance conceived by the natural world

your doing great and you are making a difference

[amydunn19]

Re: Spoke too soon, need advice

There is a marked difference for most dogs between the way they use insulin during daytime and night time. I don't think that I would be overly concerned unless you start seeing anything 100 or below any time you are testing. Then, you might want to pick a night when you can go without a little sleep, and try to do some testing.

I think sometimes we caution people so much about low numbers and when they have seen mostly high numbers and suddenly see something that gets in the normal range, there is a knee-jerk reaction. It is like you have been waiting for so long to see a good change, and you see it, you kind of panic a bit. Keep in mind when doing a curve, that you don't want to change anything unless or until you see a truly low number. If you are doing a curve, you are going to be there all day so you can always intervene later if needed. It takes nerves of steel - I always said diabetes is not for sissies.

Regulation, when done safely and correctly, usually takes at least 2-3 months even with no complications. Unless you get really really lucky.

[Aggie]

Re: Spoke too soon, need advice

Jesse's mom, I would like my husband to be more involved, but it's my personality to be kind of a control freak so it's pretty easy for him to duck and just let me do most of the heavy lifting. However, we both know there will be times I won't be home on a particular night, so he needs to learn. He has been getting up to help me with the injections in the morning, and also getting home to help at night. His role of distracting Winston is important.

Amy, I know exactly what you mean. For two months we never saw a number below 300, and then a tiny increase, and wham. Numbers in the 100s. And I did kind of panic thinking they would go too low. I couldn't believe a tiny increase of 0.4 units made such a huge difference. I'm afraid of hypos and don't want to see one, which means I'm probably more comfortable if the numbers stay over 150. It might be irrational. From my limited data, it does seem that Winston is very different day vs. night.

In all honesty, there isn't a night I want to give up sleep and wake the dog for testing. Testing his ear is kind of dicey and I need help to do it, and even so he fusses and yelps sometimes. The tail base didn't work. Lip is OUT. Winston has a few small bumps on his body which I have discovered do work for getting blood without a reaction from him. I'm not sure that's a good idea; the bumps are quite possibly low grade tumors (he has had 5 of these before). I did compare it to his ear and the number was only 10 points different. But I am not sure poking him in a possible tumor is so smart.

I wish Winston was as calm and non reactive as other dogs seem to be. But he is sensitive and it's hard to do some of these tests.

[Aggie]

The effect of food on the curve

Today's numbers, 2 weeks on 7.6 units vetsulin twice a day:

210 fasting at 6 AM. Fed and insulin 6:30
357 8:30 AM
330 10 AM
373 12 noon (very weird, usually dropping)
234 1:10 PM (better)
162 2:05 PM (low point, later than usual)
188 3 PM
260 4:10 PM
360 5:35 PM

Just need to know how to flatten out those morning numbers and we're there, or nearly so. It seems to me that breakfast jumps the numbers up beyond what the vetsulin can handle early in the day, and that maybe the insulin just runs out late in the day. I've gotten conflicting opinions about what to feed to improve this, assuming food is, indeed, the morning culprit. Has anyone had a similar pattern and fixed it somehow? Also, does anyone know why the morning fasting is considerably lower than the evening fasting?