Mik is gone...

[eyelostit]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Still, his barking is music to my ears...

And Mik ate !!

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

worry here.

it's been three hours since the 2 units and mik is eating well, another 3/4 jar of baby food and kibble.

a minute ago, he began walking and stumbled, walked like drunk, his legs kind of collapsed once. he finally got going to the kitchen, he is eating agian

what are the signs of hypo?

is three hours beyond the worry time or..?

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Robert,

It sounds like he is too low to me. Give him some syrup about a teaspoon total--rub that on his gums and try getting some under his tounge. Be careful not to choke him with the syrup.

Let us know and then we'll talk about following it up with food in a bit, but please go with the karo now.

Kathy

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

That was my plan but wanted to check first.

Gave him about 1/2 tspn of maple syrup, which i'm told is stronger [glucose] than karo.

more
should have noted that his craving for water is still high--not AS high as yesterday, but methinks above normal

more more

I have decided to not give him the 25% in the am, and should be home by noonish for his first meal + insulin

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

The only time I had to use anything like this, I used pancake syrup. Lucky was at 35 and had no signs of being low. It was when we were initially regulating him.

http://www.bddiabetes.com/us/main.aspx?cat=1&id=399

SYMPTOMS OF MILD HYPOGLYCEMIA

Sudden ravenous hunger
Shivering
Weak, lethargic, unusually tired
MODERATE HYPOGLYCEMIA

Disorientation
Trouble with vision
Poor coordination, such as staggering or walking in circles. The dog may act 'drunk'.
Changes in head or neck movements
Restlessness
Urgent barking
SEVERE HYPOGLYCEMIA

Convulsions, seizures or 'fits'
Passing out

To jump-start a dog's blood glucose, give it light or dark corn syrup (such as Karo® brand) or maple syrup that can be absorbed quickly into its bloodstream. Give one teaspoon of syrup to a small dog, and one tablespoon of syrup to a large dog. The effect of syrup does not last long, but it works quickly to reverse a low blood sugar situation. Follow up the syrup treatment with a regular feeding to stabilize the dog's blood glucose. Sweet syrup can be applied to the animal's gums, inside of cheeks or inside of lips.

You should see Mik responding to the sugar pretty quickly. Then he's going to need to take more food--whatever he will happily eat--to make sure he doesn't have another problem.

I would work at feeding him as much as possible so that he doesn't have another problem when the insulin gets to working hardest and that would be roughly between 4-8 hours after the shot. The actual "peak" time will depend on how the individual dog uses insulin; right now we don't know this about Mik so we can't predict what his "peak" really is.

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

With what happened, I think you're right to skip the morning insulin because you need to reach the vet to let him know that a total of 2.5 IU was too much for Mik today.

Now understand that because of the syrup and more food, Mik will be running high, but it's nothing that can't get straightened out. Whenever you think you're seeing a hypo, it's best to treat it and worry about straightening out the bg's later on because a hypo can kill. You have time to fix the higher than normal bg's, but even if you're wrong about thinking it's a hypo, better to be wrong and need to work on the bg's than to be sorry.

I think Mik's going to need to use less than a total of 2.5 IU, know that your vet needs to be advised of where 2.5 IU took him today and that he should be able to give you a dosage adjustment because of this. Mik may need only 2 IU or perhaps 1.5 IU total right now. I think you should have his input on a new dose for Mik.

How is Mik now?

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Excellent info, many thanks.

The problem is that Mik's displayed many of those symptoms for some time, and I think a lot of it results from his sudden blindness. He is confused, walking into things, and learning to find his way around.

One little trick he has. Mik knows precisely where I sit at my computer which is on a desk. He walks toward me until he literally runs into my leg, then turns left, hits the desk, and turns right to his little bed. It's odd, but he has it down pat.

I faxed the vet about Mik's status, and that I'm skipping the morning shot. I have decided to never leave him after a shot of any size. I gave him about 1/2 tspn of maple syrup, which he LOVED, and then put him down. After a while, he seemed to walk a lot better.

It's almost 10 pm here, past his normal bedtime so he went to his bed. He ate so much for dinner, that I don't have much hope of more, but we'll see.

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

When you see something that looks like it may be a hypo or low and you give syrup then see improvement not long after that, then you know it was a low you were treating because giving a sugar source doesn't help anything else.

I'd keep a check on him tonight to make sure he's OK. While I think you're right if he ate well, it should take care of the peak of the insulin, but best to be sure. If you can get any more into him, I'd sure try.

We once had a situation on another board years ago where the dog had gotten his dinner and evening insulin and shortly thereafter threw up the dinner plus had a hypo. The evening insulin hadn't been in him long enough to cause it, so it had to stem from the earlier dose.

We kept him out of the ER by feeding him peanut butter and jelly sandwiches so he'd be high enough that when the evening insulin did peak, he sure wouldn't have another hypo!

I think what kept Mik on his feet yesterday after getting the 5 IU was the fact that his bg's were so high. Now that they've gotten down to more reasonable levels, he has less resistance to the insulin.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

We kept him out of the ER by feeding him peanut butter and jelly sandwiches [snip]
I think what kept Mik on his feet yesterday after getting the 5 IU was the fact that his bg's were so high. Now that they've gotten down to more reasonable levels, he has less resistance to the insulin.

PB & J! Great idea! Will keep it in mind. Yes, I agree on your yesterday comment. His readings were very high, and the 5 IU jolt brought him down to near normal, but that amount is WAY too high now.

I'm wondering about 2.5. Will discuss with vet tomorrow.

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

My thought is that it needs to be less than 2.5 IU because that's the amount Mik had today and you needed to get the syrup. The very high bg levels are no longer there to create so much resistance. When you get rid of resistance, you need less insulin.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

The very high bg levels are no longer there to create so much resistance. When you get rid of resistance, you need less insulin.

Understood and agree. I'm going with about half or 1.50, and then test strips. I know ketones should be negative, but glucose around 200 or so? Less?

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new strip

ketones = negative
glucose = I'm hard pressed to say 100 or 250. The color graduation is so slight, I could go either way. So, about 175-200?

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

While your ideal is to get down to under 200 with the glucose, I wouldn't get upset about that right now. You can get there with careful tweaking once we can establish how much insulin Mik should be using now, in light of his going low tonight.

I would think about the under 200 after Mik gets onto a dose that keeps his bg's down and away from the horribly high ones he had which created the ketones and keeping the ketone check at negative.

The main thing now is to find a number of units for Mik which will do that--keeps them in check, keeps him eager to eat and he's stable on--meaning that his bg's are steady--no real highs or lows.

Once we can get there with Mik, you and your vet can adjust his dose a little where it might be needed to stay under 200.

Once Mik is at or under 180 (renal threshold), you won't be seeing any glucose results on the urine strips because the glucose won't spill over to his urine. This is where being able to test blood comes in handy because when we get a negative result on a urine glucose strip, all we know is that he's at or under 180--how much under only blood testing can tell us.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Sounds good to me--thanks.

He did wake up and I managed to coax him to eat about 15 kibble nuggets. He went back to bed, and sleeping peacefully, gentle breathing, no abrupt movements.

[We Hope]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

I'd keep an eye on him because it's been just about 6 hours since he had the shot--we are in the area of 6-8 hours where the insulin you gave him then will be working its hardest.

My thought is that when Mik was eating so well earlier, the food he was enjoying had yet to start digesting (turning into glucose), so that will be a help to fending off the peak.

Your getting him to take more kibble is more "insurance" against him having a problem.

But if you even think you see any hypo signs, don't hesitate to do what you did earlier.

[robertpri]

Re: Mik: 13 yr old Shih-Tzu: importance of scheduled meals & insulin?

Yes, will do. I am accustomed to recognize his normal 'trouble-free' sleep.