Scooter's cataract

[Scooterspal]

Re: Is there a number that equals "stabilized"?

It happened again this morning. Tested at 2:00am and he was 49. Gave him two doses of corn syrup.

Off to the vet today to check on his eyes. Want to get to the bottom of this, as well. I will have a two day chart for him to examine.

[MikeMurphy]

Re: Is there a number that equals "stabilized"?

Looks like you need to go lower with his insulin dose. Maybe his skin infection is starting to clear up, causing him to require less insulin. Good thing you are home testing.

[amydunn19]

Re: Is there a number that equals "stabilized"?

Without seeing the curve, it may just be that you are seeing very low numbers and a dosage decrease is needed. Somogyi is more of a swing caused by too high of a dose. Like a large difference from high 400’s to 40 or 50. If you are giving him sugary things (after the lows occur) to raise him back up, that could be where the higher number comes in. But, either way, he obviously is on too large of a dose. Very scary times! Glad you are monitoring. Do you have any numbers to post for the entire day?

You mentioned closely monitoring for a period of hours(like a curve where you test every two hours from his morning meal to evening meal.) Until he is settled on a dose, curves actually should be done more often. Since you test at home, it should be easy. If you want input, you can post your readings and get some input. You don’t have to do a spreadsheet -just put down the time and the reading and any food and dosage of insulin that you gave at that time.

[Scooterspal]

Re: Is there a number that equals "stabilized"?

My vet was very surprised to see my two-day, 24 hour chart yesterday. I got the feeling the last time was in medical school.

"Classic Somogyi" was his reply. We agreed a lowering of the evening dose was in order. I now give him 4 units in the evening and stay with 6 in the morning. Testing at 2:00 am this morning and he was 127. This is a number we can live with.

I have posted the link to my chart for others to review and maybe some newbies to learn from. You don't know what you don't know and with this horrible disease, that can kill you or your pet.

https://s1.postimg.org/1btcrd6vov/image.jpg

I also got new anti-inflammatory medication for his eyes. This should cure the redness and pain. He will still need the Optimmune ointment for the dry eyes (KCS) for the rest of his life to help him make his own tears and I need to instill OTC lubricating drops every now and then, for added protection. I'm using carboxymethylcellulose sodium drops from Wallgreens. A generic version of a brand name. They create a coating over his eyes you can clearly see.

My charting will continue until I feel he is back on track. Back to the vet this coming Friday.

[MikeMurphy]

Re: Is there a number that equals "stabilized"?

Good job with the 24 hour curve. It’s often said that a picture is worth a thousand words. Sure looks like Somogyi Rebound to me and the only solution is a reduction in insulin. I wouldn’t be surprised if a reduction in the morning dose is also needed. Keep spot checking.

Hope you don’t mind, but I’ve include your curve in my post...

[Scooterspal]

Re: Is there a number that equals "stabilized"?

Scooter was 270 at 8:00 am this morning. That's the lowest he's been for that time period in a week, so the lower evening dose may be helping.

What I'm working now is whether feeding before or after his morning walk makes a substantial difference. Will try it each way and chart the results.

[Raysaint]

Re: Is there a number that equals "stabilized"?

Just be careful getting the morning and evening doses too different. I learned the hard way, and realized that consistent dose amounts are better.

Feeding before walks may be better, as the body needs fuel for exercise, and without food, the liver may release sugar and make blood sugar even higher. I usually wait an hour after eating.

I learned many years ago with myself, when my morning sugar was high, I'd do my insulin and not eat, thinking that would bring me down. I'd check an hour later and find my sugar even higher. My doctor explained that eating gets my metabolism going, and fuels my body properly to work in tune with the insulin.

[Scooterspal]

Re: Is there a number that equals "stabilized"?

Here is a question for you. This came up yesterday but likely will happen again. I needed to get up early Sunday for an event. Tested Scooter at 2:30am and he was 217. After breakfast and getting dressed, I got Scooter up around 3:45am and off we went.

Forgot his AM food! So gave him a couple of treats and left him alone to go back to sleep. No shot.

His levels did rise to about 550 by 1:30 when I got back to where he was. Gave him another treat and 4 units. Then he had a good walk and we headed for home.

Fed him his evening meal at 7:00pm and gave him his evening shot of 4 units at 8:00. Waited an hour, this one time, for the food to get into his system. By then he was 472.

Got up at 3:30 this morning and he tested 106.

So, all I all not a great day, but we got through it OK.

What do you folks do if you miss a dose in the morning?

[jesse girl]

Re: Is there a number that equals "stabilized"?

onetime i missed jesses dose do to helping my son but it was planed .

she was higher a bit gave her a bit more insulin at normal time and she settled back into her routine

most times they will do ok with a temporary change to the routine

[Raysaint]

Re: Is there a number that equals "stabilized"?

If you miss a dose, not much you can do except get back to normal routine with the next shot. They'll correct themselves within a day or two.
If you increase the next dose after a missed one, increase ever so slightly so the body doesn't react to a " new" dosage.

I spent weeks/months in the early stages trying to correct numbers, and just made it worse and delayed his regulation process. Consistent dose amounts is the best usually.

[Scooterspal]

Re: Is there a number that equals "stabilized"?

Scooter saw the vet today. He checked on the progress of his eyes and skin. The inflammation in his eyes has cleared up nicely and he is now back to making his own tears thanks to the Optimmune he gets daily now.

I brought along another 48+ hour chart for Wednesday and Thursday of this week. He is no longer tanking down to 50 in the early AM like before the change to 4 units in the evening, but now his levels are all mostly above 250. Last week they were just the opposite. Frustrating!

He suggested we change his insulin to try and get a handle on these wide swings in levels. He gave me two options and I want to get some feedback from you folks, please.

First, we mix the Novolin N he is getting now with Humulin N, the fast acting version. He said this can be tricky.

Second option, switch to Lantus. This is a time release insulin. This should be easier but a bit more money. He did say I may need to use less so that can help with the cost.

Comments?

[CraigM]

Re: Is there a number that equals "stabilized"?

You might have mistyped, but Novolin-N and Humulin-N are nearly identical insulins: both NPH.

The faster type is either Novolin-R or Humulin-R. Novolin-R is also a $25 insulin from Walmart.

I mixed Novolin-N and Novolin-R for possibly a year for Annie. The mixing itself isn’t all that “tricky”, just need to know the proper procedure. I think the mixing procedure is discussed on the data sheet that comes packed in each bottle of Novolin-N and Novolin-R. I’d also watch a few YouTube videos for “mixing N and R insulin”. Of course if someone doesn’t feel comfortable mixing the insulins in a single syringe, they could use two separate syringes.

Craig

[Scooterspal]

Re: Is there a number that equals "stabilized"?

You might have mistyped, but Novolin-N and Humulin-N are nearly identical insulins: both NPH.

The faster type is either Novolin-R or Humulin-R. Novolin-R is also a $25 insulin from Walmart. Craig

You are correct. Just looked at the script and it calls for the R version mixed with my current N, or going with Lantus.

Can I ask you how it worked out? Were you getting tighter control over the daily levels and were they under 250, if you can recall?

Also, I think I need to work on my injection technique. Please watch this video at around 6:40 where he does the injection. He jabs right at the base of the pinch. I was instructed to jab about half way up parallel to the dogs back. Honestly, with Scooter squirming around when he sees the needle I'm lucky to get it in anywhere. However, I may not be doing it correctly and this may be partly responsible for the wild swings in levels.

Is this the method you folks use?

https://youtu.be/Y3GUvm2Ujvk

[Raysaint]

Re: Is there a number that equals "stabilized"?

It's probably not your injection technique, the pinch allows you to hit the subcutaneous layer easily.

My one concern is the 2 different does, 6 morning, 4 at night. My experiment with 2 different doses didn't work. I would have liked to see what happened if you made each dose 5 units, and then adjust food slightly to compensate if needed.
It's what I do now, once I got his doses back to being the same, if his fasting is low, I add some brown rice to increase carbs because his normal dose is a bit too much with low fastings.

Lantus probably won't work because it has no peak to help bring down post prandial sugar rise. Lantus alone wouldn't work for me, I have to use fast acting with each meal. Lantus alone would only work if you ate many small meals a day.

And if you use fast acting (R) with NPH, you may have to guess/adjust the R dose everyday depending on fasting sugars. I wouldn't want to do that.
R insulin doesn't have the flexibility of NPH. I adjust my R insulin at every meal because I know it's going to reduce my sugar a certain amount.
With longer acting insulin, the body can help regulate how it uses it (it's not as linear) and you can add snacks if you need to during the NPH time range.

[MikeMurphy]

Re: Is there a number that equals "stabilized"?

Can you post your last curve?

In regard to an insulin change, I’d be careful with Lantus. It is mainly used for cats and has proven to be unreliable with dogs.

I use a Novolin N/R mix for Lily to correct a big rise in BG after eating. For her it has an added advantage of prolonging the duration of her N to 12 hours. She was pretty much regulated prior to going to the N/R mix, so this was a tweak to get tighter regulation.

For reference, here is her curve with Novolin N, followed by her Novolin N/R curve. Things change over time. She is currently on 13 units N and 3 units R.