Decker made his journey to the bridge Jan 26, 2013

[jesse girl]

Re: New to doggie diabetes

remember it is possible the dose may need to be reduced further that is a dramatic change

[momofdecker]

Re: New to doggie diabetes

I'm glad to read your post because I was wondering if that might be the case. Should I give him a couple of more days to adjust to the 20 units or start to reduce sooner? If I do reduce, do you have a recommendation as to what to reduce to? Thanks, Holli

[jesse girl]

Re: New to doggie diabetes

i think you must look at the history of dosing with your baby what dose was he on before the dramatic rise in dose and what was the trend and level at that time presumably during the honeymoon period .

you said you skipped the dose this evening was this due to the lower fasting number .

if the dose was skipped the numbers should be much higher but if this honeymoon process may stll be going on you might see numbers in the 200s

since the fasting number was so much lower my thought would be 15 units and i believe natalie had that thought as a possibility.

even if your at a higher fasting i would still go with the lower dose and maybe you can do a curve on Sunday and of coarse test at fasting and maybe the usual low points .

you want to find a dose that keeps him from going to low and stick with that dose for 5 days if in the 200s that is fine for the most part and maybe next weekend you can do another curve and reevaluate

[MaryLea]

Re: New to doggie diabetes

you want to find a dose that keeps him from going to low and stick with that dose for 5 days if in the 200s that is fine for the most part and maybe next weekend you can do another curve and reevaluate

Exactly! You base the dose on the LOWS, not the highs. Once you find a dose than does not take him too low, you begin regulating from there.

Since he's gone so low on 20 units, you need to reduce the dose again. You ALWAYS reduce the dose for a low; don't wait for the "5 days" to pass. Then you begin counting another five days at the time of the reduced dose. Hope that makes sense. In your case, if you give him 15 units tomorrow AM and PM, that is day one of a new cycle.

Watching and cheering you on,

Mary

[momofdecker]

Re: New to doggie diabetes

No shot tonight due to lower number and large drop. Wondering if tomorrow will reflect more rebounding effect. Though 120 should be a good number he has been at the water bowl pretty consistently tonight. Numbers from December have been all over the place. The last two days are the most consistent that we've seen.

He was as the vet's office two days in early November so that an accurate dosage could be determined. Honestly, I was mortified at how awful he looked when he came home. He was saturated in urine, hoarse and his eyes were extremely blood shot. He could barly push himself up on his back legs. He would walk holding one back paw up completely. He did nothing but sleep for two days. We were told a safe range was 60-200. And were instructed to give 40 units twice a day and to bring the results in after a week. Have two dogs and two cats and have been going to the same vet for ten years. Never had a problem but also only had routine visits and routine shots. Feeling like it may be time for a change....

November:
9th
Morning 232 - 40 units
Afternoon 173 - 40 units

10th
Morning 84 - no shot
Afternoon 59 - karo syrup and food. no shot

11th
Morning 98 - no shot
Afternoon 173 - 40 units

12th
Morning - no test
Afternoon 118 - no shot

13th
Morning 192 - no shot
Afternoon 216 - 40 units

14th
Morning 55 - karo syrup and food. no shot
Afternoon - no test

15th
Morning 278 - 40 units
Afternoon 134 - no shot

Spoke with vet at this point. Vet said Decker was probably in honeymoon stage. He also noted that we seemed to give shots when his bg was high and to not do that because the insulin took up to six hours to work and that his bg could drop before the insulin kicked in. Vet said we didn't need to test daily and to go more by his behavior and test if we felt necessary. There was a period where we tried that, but to us, it seemed necessary to test. Then in December things seemed to go from bad to worse...We were also told that we could keep him on his regular food - no special diet is necessary. He eats beneful healthy weight dry food. Prior to diabetes he was fed once in the morning. Were told to feed him at least twice a day. Up to four times a day if possible. He is now fed twice a day and we were trying to leave food out during the day for him to 'snack' on but it has not been working - it's gone before I'm out the door for work.

December:
5th
Morning 373 - 40 units
Afternoon 68 - no shot

6th
Morning "hi" which means 600+ - 40 units
Afternoon 600+ - 40 units

7th
Morning 534 - 40 units
Afternoon 600+ - 40 units (started new insulin)

8th
Morning "lo" which means bg is under 20 - karo syrup and food. No shot
Afternoon 68 - Karo syrup and food. no shot

9th
Morning 600+ - 40 units
Afternoon 454 - 40 units

10th
Morning 570 - 40 units
Afternoon 420 - 40 units

11th
Morning - No test
Afternoon 290 - 40 units

12th
Morning 74 - no shot
Afternoon 21 - Karo syrup and food. No shot

13th
Morning 600+ - 40 units
Afternoon 44 - no shot

14th
Morning 518 - reduced to 20 units
Afternoon 386 - 20 units

15th
Morning 333 - 20 units
Afternoon 120 - no shot

Holli

[ozzi]

Re: New to doggie diabetes

Isn't it amazing how much better Decker is doing with less insulin! YAY!! You are clearly on the road to adjustment. I had similar issues with Ozzi, and when I got on this forum, I essentially started over with getting him adjusted because he was never regulated until I got help here. That's essentially what you are doing now.

Don't be discouraged tomorrow morning if his reading is a bit high. That would be expected because he had no insulin and presumably he ate tonight. But that's okay because it's better to have him run a little high than low.

I would definitely check his BG in the morning before feeding him. Since the 20 units brought him down to 120 tonight, I would probably reduce it in the morning (even if it is a higher reading which I would expect) to 15 units. Remember that he was getting 40 units twice/day until last night, so there is some overlap and it will take a few days for that to "wash out" if you will. I think it would be safer to give him 15 units twice/day for the next 3 days even if he's running a bit high, and THEN start to make upward increases slowly depending on what his numbers are.

That's my opinion of what I would do if Decker were mine, and I think others will chime in before tomorrow morning. He may well end up on 18-20 units every day, but right now he still has some residual effects from when he was given 40 units, so if you can get him under some better control now (still running a bit high but not in the 500's), you will be able to make further adjustments in about 3 days.

I'm REALLY REALLY excited that Decker's behavior has improved so dramatically. You did good!!!!

Kevin

[ozzi]

Re: New to doggie diabetes

Decker won't have a rebound effect tomorrow because he had no insulin tonight. Rebound occurs when too much insulin is given and the body puts out "emergency" sugar from the liver, causing the BG to dramatically increase. He will however have a higher than normal BG reading in the morning simply because he ate and had no insulin. This is not rebound, but rather a normal response to a diabetic eating with minimal insulin on board. So don't worry about that.

I do think reducing his insulin to 15 units twice/day for the next 3 days would be a conservative way to go. He may run a bit high, but I think he needs this time to adjust to a lower dose. As I mentioned earlier, you are really starting from scratch. What I can tell you is that if you had continued 40 units twice/day, he would really not be doing well today, so running a little high for the next 3 days with a lower dose is better than risking him going low.

I found that feeding twice/day in MEASURED amounts was crucial to getting Ozzi regulated. I would absolutely discourage you from feeding four times/day...ugh! Since the extra food you leave for him to snack on isn't really working out, I would really not continue to do that. It will only make it more difficult for you to get good control of his BG.

Honestly, after reading what you just wrote about your experience with your vet, I was horrified. If my dog EVER came home from the vet in that condition, it would be my last visit to that vet...just saying! You and Decker deserve way better than that!

Kevin

[CarolW]

Re: New to doggie diabetes

Holli - I'm impressed with how well you're doing with Decker. Nice job! I hope you're now truly on the road to better things for Decker and you.

I agree with all that Kevin said. Glad you keep good records.

And I REALLY blanched when I read about the condition in which Decker was returned to you after the initial diagnosis and hospital-stay. Yep; that would have been MY last visit to that vet, too.

Hope you can find a really good vet in your area.

Cheering you on, Holli - you and Decker!
Thu, 15 Dec 2011 20:28:36 (PST)

[MaryLea]

Re: New to doggie diabetes

I'm so sorry you and Decker have been through so much, and partly, it seems, at the "hands" of a vet. But I am more grateful that you found this site and some reasonable advice. I know they saved our Ruffles from an earlier death.

You've done very well under some extremely difficult circumstances. Good for you! Decker is fortunate to have you!!!

Mary

[ozzi]

Re: New to doggie diabetes

Hey Holli,

I forgot to ask about Decker's accidents! I know he is acting more like himself in terms of energy level, etc., which is AWESOME, and I wondered if the accidents have dissipated? If they haven't cleared, I'm sure they will very, very soon. I just wanted to make sure he was on his way to getting out of the basement!! ha ha

If you do look for another vet, you might want to get some suggestions from people here about how to go about it. I know that I have read posts in the past (probably a year or more ago) where people had similar frustrations about their vet or his/her knowledge of diabetes and BG management or were just uncomfortable for whatever reason, and they posted information that was helpful in finding a vet that was open to working with them on managing their diabetes. Apparently some vets discourage home testing (don't ask me why!) and that would not be the best match. My vet never mentioned it and I only started doing it because I came here. She wasn't against it at all, but never encouraged it until I started bringing in BG curves and making insulin adjustments with her "guidance." In time, she told me that Ozzi was her best regulated diabetic patient, and clearly saw the value of it. So I think it's important to choose a vet just as you would choose your own doctor, and I know that people here who have experienced a similar situation to you can offer sound advice.

Kevin

[k9diabetes]

Re: New to doggie diabetes

Given the risk from what you've seen the past couple of days, it would be wise to cut his insulin back further still. I too recommend going down to 15 units.

You want to get to a point where you never have to offer additional food or skip insulin because the blood sugar is lower than you are comfortable with.

Once you identify that dose of insulin, then you can inch the dose upward in tiny increments, giving each new dose at least 5 days to settle in, until you find exactly the one that works best for him.

Once you have a dose that gives him his best blood sugar, there are other things you can tweak to improve his regulation if needed.

But first you have to identify the dose and you always always want to inch UP toward it. So don't hesitate to drop his dose farther now to try to find the point where it's not enough insulin. That will be your start-over point.

When you consider that his blood sugar hit 120 on half as many units... wow, I'm just so glad that you got in touch with the forum and got him off of the 40 units of insulin when you did. This is something that should be addressed with the vet, for the sake of all dogs s/he treats in the future, when you can.

As Patty mentioned, constant rebounding and major overdoses of insulin can eventually exhaust the body's ability to provide stored sugar to go with all that insulin.

I've seen a couple of dogs who were massively overdosed (as in 10 times more insulin than they should have been given due to vet or vet tech error) and even those dogs survived a few days while they had stored glucose their bodies could pump into the blood to go with all the insulin they were given. But after a few days, the stored sugar was gone. They lapsed into comas and died because their blood sugar went to zero...

I honestly wonder if the vet misread the dosing guidelines - maybe confused pounds with kilograms.

Natalie

[momofdecker]

Re: New to doggie diabetes

As suspected Decker's bg read 'hi' which means he was 600+ this morning. Not surprised because he would not leave the water bowl last night and was up at 12:30a, 2a and 4a to go potty. Smart boy - glad he has learned how to wake me to let me know he needs to go out. For now he remains in the basement during the day. It's clean and warm. Probably bothers me (and the cats as they love to hide down there) more than the dogs. The night before was the first time in December we didn't get up in the middle of the night to go out. I think if we can get his numbers in a somewhat consistent range, even if a bit on the high side, the accidents will stop. It seems to be a large drop that brings them on. He received 15 units this morning, per all of your advice. I will at some point talk to the vet about what Decker has gone through - it is important for him to know that the dosage he provided was off and could have been met with fatal results. There is a vet about 20 minutes away that we went to when the cats were kittens. I plan to call and ask what experience they have with treating diabetic dogs. Would appreciate a list of good questions to ask. Thanks, Holli

[Abby's Mom]

Re: New to doggie diabetes

Holli,

We are on our 4th vet in a little over 6 months. I started calling around, and would not even go, because it became a waste of my time and hope. The last vet, talked with me on the phone about 30 mins, asking all of the right questions, and answered all the questions I had correctly (thanks to this forum and knowing a lot more, so I could ask the right questions).

Some of those questions I asked;
1. How many diabetic dogs (not cats) do you have under your care?
2. How do you go about and regulating them?
3. Tell them that you test at home and plan to, and see what type of response that you get.

I was looking for a vet that would work with me and told them that. I was going to do all I could to get Abby regulated and wanted to know if they would do the same.

I used the following link as a guideline for some questions.

http://www.caninediabetes.org/pdorg/..._questions.htm

Good luck!

[ozzi]

Re: New to doggie diabetes

Those are AWESOME questions Barb! Thank you so much for posting them!!

Holli, you're doing incredibly well. I think I'd be pulling out my hair by now if I were you! I think you will see a high reading tonight, but not as high as this morning. Since you are essentially starting over with adjustment, the 15 units given twice/day will lower his sugar more slowly, and that's what you want right now. I know tomorrow mornings number will be much better, although still high. You mentioned trying to do a curve this weekend. It would be great to see Sunday's numbers if that's possible.

I think you're doing an incredible job, and you will see Decker's numbers get better and better and more consistent on 15 units, and even better as you increase over time to get him regulated. Hang in there, BG regulation can be a very frustrating process, but the worst of it is behind you. You are absolutely on the right track now. As Natalie and Patti mentioned, you really don't want to skip insulin doses if possible, so I believe Decker's number tonight will be high enough that he will need the 15 units. Please post tonight's BG if you can. We're all watching and cheering you on!!!

Kevin

[Patty]

Re: New to doggie diabetes

I will at some point talk to the vet about what Decker has gone through - it is important for him to know that the dosage he provided was off and could have been met with fatal results.

Holli, I think this is a wonderful idea. I often worry about the dogs that follow someone who's had such an experience and switched vets. The initial vet may do the exact same thing with another dog.