Bailey got his wings... June 26, 2014

[Rubytuesday]

Originally Posted by Geoff

OK, thanks all for the support and info. So, to re-cap. I should test Bailey and then inject him with 1IU of Humalog then re-test hourly for 4 hours to monitor the Humlaog? Yes. You could play it by ear as far as if you wanted to test every hr., but I would do the fasting, hr. 3&4.
That is, a random time say midday or something? No, for right now I would just work on the food rise. as I see it that is the only real problem here as the nadir happens right before food so it isn't like he is running out of insulin. Also if you are also giving the humalog away from food it would be more confusing to figure out how it works as it is never just that that is affected. I would keep it as simple as possible right now.
Or, could I not just do a slight increase at meal times to see if it makes the slightest difference? Say tonight, 8pm, 1.25IU of Humalog? Then monitor.Yes, This would be my approach.

Wanted to clarify, did so above in blue.

Please remember as you get closer to your goal of taming the food rise it will be important to check the nadir to be sure it isn't dropping too low. As the humalog clears more of the food rise less of the protophane will be used up on it, enabling it to drop other numbers (most importunely the nadir) lower.

Tara

[Geoff]

Thanks Tara, yes I agree, giving random shots of Humalog will confuse the issue, so I will go for a small increase tonight. I have some new needles with more space between the markers so it should be easier to do 1/2 and 1/4 units. The needles are 3/10cc as opposed to 5/10cc

Geoff

[Geoff]

OK, just feed Bailey, fasting BG was 23.4, gave him 13 units of Basal and 1.5 units of Humalog. Will test him at 9:30-10 to see how he's going.

Edit - Just took a reading at 10pm of 26.7
Last night was (Tues) 1IU Humlaog 13 Basal
7:56 21.4
9:11 27.3

Tonight (Wed)

8:06pm 23.1 1.5IU Humalog 13 Basal
10:00pm 26.7

So, to my eyes he is reading better than last night given at 9:11 27.3 but tonight at 10pm he was lower at 26.7 on 1.5 Units. Still, not a massive drop. I will try (if i'm awake) to test him at 11pm (11pm was 28.3)

To my mind this Humalog is either:
A) not working
B) insulin resistance
C) gone bad (expires 2013)

I mean 1.5 IU should be doing more??


Geoff

[Rubytuesday]

I am very skeptical that the humalog isn't working. Here is what I see:

7:56 21.4
9:11 27.3
1 hr 15 min.out the humalog allowed a 5.9 increase.

8:06pm 23.1 1.5IU Humalog 13 Basal
10:00pm 26.7
2 hr.s out humalog only allowed a 3.6 increase.

I think you have preconceived ideas about how the humalog should be working and that is not helping you to see how the humalog is working. When we start out with these fast actings you need to go slow. You shouldn't expect to have the right dose right away.

Can you post a curve or food rise numbers from right before you started the humalog when he was on the same food and protophane dose....even if it wasn't the same dose. What I am looking for is to see hr. by hr. about how much of a food rise he gets and how long it lasts. As shown above when i look at progress with this I am looking at the spread between the fasting and following test and not just the top number.

Hang in there Geoff. I was the same, thought once I had the humalog I would be golden. It can take a little bit to find the right recipe.

I would suggest having a separate place for fasting numbers and humalog dose given with testing outcomes. Going forward as you get closer to the correct dose, you will have to figure out just how much to give based on the fasting readings. I found it hard to sift through all the other info in my journal to find just that info so stared a different page with just those numbers so I could quickly figure a dose.

Tara

[Rubytuesday]

So I found this. Here is what I see on the one meal when there is a fasting number.

Date Time mm/ol Comments mg/l
11-Nov 9:04am 20.9 Could not get blood at 8am Fasting 376.2
11-Nov 11:12am 25.5 459
11-Nov 12:32pm 26.5 477
11-Nov 2:16pm 18.5 333
11-Nov 3:42pm 10.3 185.4
11-Nov 5:06pm 8.3 149.4
11-Nov 6:13pm 10.7 192.6
11-Nov 7:23pm 13.3 Just before dinner 239.4
11-Nov 8:03pm 21 378 a 7.7 increase in less then 1/2 hr. here is where it becomes tricky to tell if the food rise really jumped that quickly, if he had used up all his insulin earlier or if the body was already on a hard rise prior to food. Even though the 149 wasn't a dangerous number the body may have perceived it as being dangerous because it was such a spread from the 477. You might look back at other curves to see if he went to 150ish if there was a harder seemingly food rise. That might indicate it wasn't so much a food rise only, but also the liver dumping glucose in response to the lower number. The other data to look at is on a day where he stays above 200 does he not have such a hard rise after food.
To me based on just this one day, it looks like the food rise lasts about 4.5 hrs., assuming he was fed at 8.

It really is a puzzle Geoff, and I am not saying I am right, just how I interpret what you have posted. You are with him daily and have more data then I do. I am just trying to show you how I evaluate these things.

Hopefully others will chime in. I get a little nervous trying to interpret others dog's readings, when I sometimes find it so hard to figure Ruby's out. Over time it has become clearer, but it has been many months and a lot of testing.


Tara

[Geoff]

Good morning Tara (for me!) Yes I did expect to see a dramatic drop in his blood sugar given the quick acting nature of the Humalog. Either his food rise is long and strong (looks like it) and the Humalog is having a hard time bringing it down or....not sure!

I will test again tonight at the same time(s) and see what result I get. It's hard though as you say, his dry food is 100% accurate every night but his tinned food I cut with a knife into 1/4 and they vary in size depending on how good I cut a tin of dog food in half by eye!! I mean they won't vary by much but still, it might make the difference between 27 and 26.5 for example.

I have read that Humalog can be "patchy" meaning bad batches etc. As usual with this horrible disease its hard to determine the exact cause of something with so much going on day-to-day. I also walked him last night which made no difference to his readings. It drives me mad!!

[Rubytuesday]

Geoff, I would suggest getting yourself a little digital kitchen scale. Fluctuations in the measuring amounts can be a variable that you don't want to be blaming on not enough humalog. Especially when trying to find the right dose. You don't want to overshoot with the dose on the same night you have eyeballed a lesser amount.

I really just think you aren't at the right dose yet. It took you so long to get here and you want it better now. You'll get there, just go slow and steady and keep good notes. Things you think you will remember I guarantee you you won't.

For as much as I am involved here I have never heard of anyone having a problem with humalog, doesn't mean that it couldn't happen though, or that I wasn't absent on that day.

Tara

[Geoff]

I have one! I use it for his dry food, his tinned food I just cut up with a knife, to be honest I don't know any other way to cut a tin in half, then into quarters. There would be not much in it, however, for fun? I will ensure for the next 2 nights he has exactly the same amount and see what the results are.

Geoff

[Rubytuesday]

Sounds good Geoff. Will look forward to your's and Bailey's progress.

Tara

[k9diabetes]

I would hold steady at the current amount of Humalog until you can do a fairly substantial curve and track the blood sugar throughout the 12 hour period. As I think it was Tara mentioned, when you chew up some of the excess sugar with the Humalog, that can leave more NPH around later, dropping the blood sugar more later in the afternoon when the food is mostly used up.

In other words, the Humalog could make the curve flatter during the first four hours, then deeper afterward.

Of course, it never hurts anything but the pocket book to try a different bottle of insulin.

But truly all dogs do things differently. For example, some dogs get such a sharp drop from NPH alone that they can't use a faster acting insulin, not even Regular, while Chris, on the other hand, was slow to put insulin to work and he could take Regular insulin only and have fairly level blood sugar.

It's hard to wait I know, but it actually gets you there faster because there's a lot less guessing.

Natalie