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  #11  
Old 09-28-2009, 09:29 AM
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Default Re: Annie needs help

From what I'm hearing about Annie's regulation, a large swing in blood sugar is not a problem. On good days she maintains within a nice tight range. But her blood sugar levels have some variability so some days she goes too low on the same dose of insulin. With those wobbles, it won't be possible to maintain such tight regulation - the good days will have to run a bit higher to keep the low days from going so low.

http://www.vetsulin.com/vet/Monitoring_Somogyi.aspx

This looks like classic rebound to me... just the kind of thing that if one didn't catch the 66 and only saw the 485 and might up the insulin still further when actually a decrease is what's needed to prevent the rebound.

Looks like it may be mainly a night problem. I'm anxious to hear more about how often Annie experiences this.

Natalie
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  #12  
Old 10-02-2009, 09:09 PM
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Default Re: Annie needs help

We don't want you to think we have left this forum, I do read it everyday. Thanks to everyone and from your comments, and what I've read, it does look like Somogyi Rebound / Over-swing. I've REALLY tried to reduce the dose of Vetsulin, but I panic when I see BG readings of 400+, and then break down and give a full "normal" 6 units! Today was typically hard to accept:

4AM = 101
8AM = 414, fed, gave 6 iu (had been the "normal" dosage)
11AM = HI
1PM = 473
3PM = HI
5PM = 422
8PM = 493, fed, gave only 4 iu to "kick" the rebound???

I'm sure you see why I want to give the "normal" 6, or even 7, units when you see readings over 400.

Additional info: My wife and I were on vacation for three weeks last month and Annie was living with our Daughter-in-Law. She is a Vet Tech and reduced Annie's food intake because she thinks Annie is overweight. Annie had been getting one cup of can / dry mixed for each meal. Meals were reduced to about 3/4 cup mixed. That's a 25% decrease in food. I'm now wondering if there is a correlation between food quantity and Vetsulin dosage? Seems like there should be. If this is true, then Annie's "normal" dosage should be reduced, right?

I'll do another test at 10PM and midnight. If this is Somogyi Rebound, should I see BG come down even though I only gave 4 iu at 8PM?

Thanks!
Craig and Annie
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  #13  
Old 10-02-2009, 09:57 PM
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Default Re: Annie needs help

Craig,

First of all, you're right in that less food usually means less insulin; the doses you're giving take both basal (body's needs without considering food eaten) plus the insulin needed to properly deal with the food.

The thing with rebound is that what's making for the higher numbers are the lows too much insulin's creating.

When the system hits a low, other body hormones known as the counter-regulatory ones, are triggered by that. One of their jobs in the body is to try to protect it from harm if the system senses a low has been reached. So they raise the bg's--sometimes very high--to try to do that.

http://diabetesindogs.wikia.com/wiki/Somogyi_rebound



Somogyi rebound-a theoretical graph of what happens if you ignore the low bg numbers and focus only on the high ones created by the lows. As the insulin dose increases, the lows become lower, causing the counter-regulatory hormones to send the bg's higher in response. The only way to stop the extreme highs is to stop the lows; this means LESS insulin rather than more because it is the lows which are responsible for creating the highs.

And from this theoretical example, you can see how the insulin increases make the lows lower and in response, the high bg's higher. It's something like throwing a ball to the ground--the harder you do that, the higher it bounces back into the air.

These counter-regulatory hormones triggered by the lows, don't just automatically cut off, they "ease" back into normal levels. This can take 2-3 days:

http://diabetesindogs.wikia.com/wiki..._Still_High.3F

"Rebound is a vicious circle, with the body going either at or near hypoglycemia from the effects of too much insulin.

"When the lows occur, the body's "self-defense" mechanisms set to work, producing hormones which are meant to raise blood glucose levels. Of course they do, and the result is hyperglycemia. The systems of living beings do very little abruptly; it's more of an easing into or easing out of a situation or condition.

"It may take a few days after the insulin dose has been adjusted downward for the high blood glucose which follows hypoglycemia to return to normal.

"Just one at or near hypoglycemia incident can release cortisol into the blood, which can keep blood glucose values elevated for up to 3 days."

http://www.vetsulin.com/PDF/20585.pdf

Vetsulin-Page 21

"Hyperglycemia can sometimes persist for as long as three days after a single hypoglycemic episode. As a result, blood glucose concentrations do not always normalize within a few days of lowering the insulin dose."

So sticking to the lower insulin dose should mean you will see Annie's bg's start to gradually reduce over a few days' time.

HTH!

Kathy
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  #14  
Old 10-02-2009, 10:13 PM
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Default Re: Annie needs help

The most important thing to know is that it can take several days with no low blood sugar for things to get back to normal. It's amazing how poor the blood sugar can be for 48 full hours or more after.

So you're just gonna have to promise yourself you are not going to "chase numbers."

Because you will actually cause Annie to have high blood sugar by overdosing the insulin. You have seen how 6 units of insulin can plunge her blood sugar from over 400 down into the 60s. So every time you give her that much insulin, you are sending her blood sugar into freefall.

When you have gone five full days with a reduced dose and NO blood sugar below 100 - because she can be going low at times you're not testing - then, only then, will you know what her body is actually doing with that dose of insulin and have a baseline for future decisions.

At that point, I'd do a curve.

My guess is that Annie "wobbles" in that once or twice a week her blood sugar runs lower than normal. That will have to be taken into account once you get her stabilized and out of rebound in how tight you run her control.

Chris had a couple of ACTH tests for Cushings and they are a lot like a rebound episode - same kind of hormonal surge. His blood sugar run much higher for two full days after.

Natalie
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  #15  
Old 10-02-2009, 10:15 PM
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Default Re: Annie needs help

Something to remember... short of more than trace ketones, there is no damage from blood sugar in the 400s short term. So she will get through having blood sugar in that range for a couple of days when you no longer try to fix it. And then she will stabilize and she won't have to do the 400s anymore!

I would very much like to see a curve once she is stable to see if she returns to that nice narrow range of BGs.

Natalie
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  #16  
Old 10-02-2009, 10:26 PM
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Default Re: Annie needs help

Kathy,
Thanks for the fast reply and info.

The good news is that the 10PM reading was 263! I'll try to take another reading at midnight, but my schedule gets me up at 3:30AM and I need my beauty sleep!

Looking back at my notes (post #12), all I saw were the 400+ readings from 8AM to 8PM. But if you look closer, there is that 4AM reading of 101! I'm wondering if I had taken a 2AM reading if it might have been a VERY low <60 reading? Now, that would make sense to me!

Looks like I better order more test strips! :-)


Craig & Annie
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  #17  
Old 10-02-2009, 10:34 PM
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Default Re: Annie needs help

Natalie,
Thanks. Looks like I was typing my previous post (one finger typist) at the same time you were posting. I'll keep Annie at 4 units tomorrow.

Craig & Annie
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  #18  
Old 10-04-2009, 01:47 PM
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Default Re: Annie needs help

Quote:
Originally Posted by k9diabetes View Post
When you have gone five full days with a reduced dose and NO blood sugar below 100 - because she can be going low at times you're not testing - then, only then, will you know what her body is actually doing with that dose of insulin and have a baseline for future decisions.

At that point, I'd do a curve.


Natalie
I'd do the same thing.

Dolly
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Dolly & Niki passed 2010, 45 lb Border Collie Mix 8 yrs as diabetic, 13yrs old. Blind N 10.5 U 2 X * Dog is God spelled backwards*If there are no dogs in Heaven then when I die I want to go where they went. Niki's food Orijen & Turkey & Gr. Beans, See you at the bridge my beloved & cherished Niki, I miss you everyday
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  #19  
Old 11-08-2009, 11:38 AM
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Default Re: Annie needs help

With all the talk about Vetsulin, I am wondering if a switch to NPH is doable. Annie is currently getting only between 5 and 5.5 IU (U-40) of Vetsulin. I'm wondering if the stronger strength of the U-100 would make accurate measuring almost too hard to do? We will be seeing our vet next month, but wonder what "you" think.

Next: a comment / question about exercise. Shortly after a meal and Vetsulin, BG usually rises. So would "you" take a walk shortly after feeding to limit the BG pop? (I read someones comment NOT to exercise near the nadir to prevent possible low BG) The problem with going for walks now is that we are entering "Wet Season" here in the Pacific Northwest!

Craig and Annie
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  #20  
Old 11-08-2009, 12:12 PM
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Default Re: Annie needs help

Actually, one nice thing about the U100 syringes is you can get BD syringes that have half-unit marks. We loved those for Chris and I adjusted his insulin by quarter units. He was getting about 7-8 units per injection.

Some folks who need glasses to read have used a magnifier to fill the syringes. My husband needed one for his genealogy research and got a nice freestanding one that would work well for syringes.

But in my experience it's only when you get down to 1-2 units that it's hard to work so close to the end of the syringe.

I wouldn't hesitate to try Annie on NPH.

Some people have walked their dogs to bring down high blood sugar but I am not sure how well that really works.

It brings the blood sugar down at first but may also cut the duration of the insulin so it doesn't last a full 12-hours and you just wind up moving the higher blood sugar to another time of day.

It's the kind of thing where if you take from one spot you have to give up something in another spot.

I am not concerned about a post-meal spike as long as it's brief and not terribly large. In the grand scheme of things, if the blood sugar mostly is in a good range, an hour or two that is higher than you want to not a big deal.

Only way to know is to try it and test fairly frequently. Do a curve when you try it so you can see what happens right after the walk, an hour or two later, and especially from 9-12 hours when the walk might affect how long the insulin lasts.

Natalie
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