Struggling with high fastings and short duration of effect of insulin

[MikeMurphy]

Re: Struggling with high fastings and short duration of effect of insulin

I see that Dexter takes thyroid meds. Did he start taking them after being diagnosed diabetic?

If so, thyroid meds can have a dramatic effect on a dog’s insulin requirements and usually require a significant decrease in insulin.

[Raysaint]

Re: Struggling with high fastings and short duration of effect of insulin

Sometimes when the body needs fuel, and it has no food, the liver releases glucose; and more so if there is little insulin left, which may be the case late into the insulin's duration. Your big increase comes late into the insulin's run.
Having a bit of carb later in the day may help keep the liver at bay. A small biscuit type treat or dehydrated sweet potato treat, etc.
Kinda like what Daisydog was saying.

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

Hi Mike,

Yes, he started taking Thyroid tabs about 4 months ago. At the time he was on 7.5/8u Novolin and you're right it did reduce his need for insulin.

I see that Dexter takes thyroid meds. Did he start taking them after being diagnosed diabetic?

If so, thyroid meds can have a dramatic effect on a dog’s insulin requirements and usually require a significant decrease in insulin.

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

We'll certainly give that a go, thanks.

Sometimes when the body needs fuel, and it has no food, the liver releases glucose; and more so if there is little insulin left, which may be the case late into the insulin's duration. Your big increase comes late into the insulin's run.
Having a bit of carb later in the day may help keep the liver at bay. A small biscuit type treat or dehydrated sweet potato treat, etc.
Kinda like what Daisydog was saying.

[jesse girl]

Re: Struggling with high fastings and short duration of effect of insulin

sugar is quite unstable with a 450 point drop and rise

I consider this type of curve to be a bit challenging and i had the same problem with jesse which is a steep hard drop after shot

Actually the early shot could be exacerbating the situation . My priority with jesse was slowing that drop down and it took some trial and error to finally figured out what worked

The clearing of excess sugar to fast can create an unstable situation

[MikeMurphy]

Re: Struggling with high fastings and short duration of effect of insulin

Here's a mini-curve from yesterday which is indicative of the kinds of readings we have been getting for the past few weeks. Before then his fasting readings were between 19 and 24 mmol/l (340-430) typically.

I should mention that when his fastings are very high we inject around 20-30 mins before food. I realise that is often frowned upon for valid reasons but in the past it has worked for us - gives the insulin a head-start and helps bring his BG down into a good range.

7.15 a.m (fasting) 33.9 mmol/l (610)
(inj 6.5u Novolin N at 7.30 a.m. Food at 8.00 am)

12.15 p.m 14.6 (263)

2.00 p.m 8.5 (153)
(small snack of plain chicken given)

5.00 p.m. 16.8 (302)

7.15 p.m. (fasting) 36.9 (664)

As you can see there are massive swings both down and up. Note in particular the upwards swing between 5 pm and 7 pm of nearly 20 (360) in 2 hours. Too much insulin? Or something else going on?

That’s a huge swing!

Assuming something else isn’t going on, big swings like that usually point to too much insulin. A normal starting dose of Novolin N for a 7kg (15lb) dog would be 15lbs x .2 units per lb = 3 units twice daily.

Somogyi Rebound can occur if a dog’s BG drops too low or it can occur if there is a rapid drop in BG. Going from 610 to 153 and then to 664 sure looks like rebound to me.

I would reduce insulin. The problem is how much to reduce. I know schnauzers usually require more insulin, but it might be worth a try going back to 3 units. Then you can be pretty sure you haven’t gone past the proper dose.

It’s hard to start over, but at least it would rule in/out rebound.

[amydunn19]

Re: Struggling with high fastings and short duration of effect of insulin

Those swings are huge and I agree with Mike. I would reduce.

[CraigM]

Re: Struggling with high fastings and short duration of effect of insulin

Just want to confirm you are using U-100 syringes with the Novolin-N?