Lost control of glucose level

[Mom of Bruno]

After my 9YO yellow Lab, Bruno (95 pounds) was drinking a lot of water, taking a long long time urinating, and sometimes wetting himself in sleep, I took him to the vet with a urine sample. There was glucose in the urine and the blood sample came back with a glucose level of 601. He started him on 10 units of insulin twice a day. After a week it was at 475, and his dose was increased to 12 units. The next week it was at 499, and we went to 14 units. I changed his diet to Precise Holistic complete, turkey and Lamb meal, garbanzo bean formula and freeze dried liver treats. Last Saturday he was at 399 and we went to 16 units. Vet increases dosage 2 units a week until he's stable. He says it's better to have him too high than too low.
I feed him one and a half cups of kibble with a few T of canned chicken breast and almost a cup of vegetable broth poured over the kibble twice a day 12 hours apart followed with his injection, then a little piece of the chicken after. I also give him about a half cup of the freeze dried liver treats during a walk and at bedtime.
His only exercise is two walks a day at a slow pace for about 30 to 45 min each. This seems to make him very tired.

Any suggestions are welcome. This site has been very helpful.

[Brenda malamud]

Re: New here too

Hi, My name is Brenda and my 12 year old Mini Dachshund, Oprah, was diagnosed last week. Like your dog, she was drinking a lot of water with increased peeing to the max. I live in Toronto and her glucose was at 28 when it should be at the highest at 6. She's planned for her next curve next week. She gets 3 units a day, 2x a day. Oprah is my second diabetic dog. Oscar's story can be found on petdiabets.com. Bruno is a big boy compared to Oprah at 14 lbs.

From my experience it can take time to regulate these fur babies. Oprah's food was changed completely where she gets 1/2 can w/d wet and 1/2 cup 2x a day.
She gets a mall freeze dried treat like cod or salmon after her injection. She gets extra food She doesn't ask for treats but gets extra kibble which she loves as a treat. I'm just happy she loves her food because two months she lost her appetite as a result of pancreatitis. I know some folks don't agree with prescribed food but it works for her.

Hang in there!

And, you could you please tell me how to post on this site? lol.

Best,
Brenda

Oprah dx 20/4/2017, and Mozart 15 years old non diabetic
Toronto, Ontario

[Linda1]

Re: New to this

Barbra, I'm so glad to see you made it over to this site. I've been wondering how Bruno was doing. I know that you will get lots of helpful information from the long time members.

[Mom of Bruno]

curve questions

How often do you do a curve? More often when finding the right dosage?
What is the goal? Between 100 and 200? I tried one a few days after I got the One Touch:
0.......430
2hrs...382
4hrs...357
6hrs...435
9hrs...444
12hrs..404
Is it important to note when he got exercise? He gets about a half hour walk 2 to 4 hrs after eating.
How much does stress affect the numbers? He seems very stressed when at the vet's office.
I have been testing once a day at 6 hrs after his first insulin. It has been in the high 300s for the last few days. Is it best to let it stabilize over a week or two before increasing insulin?

[Aggie]

Re: curve questions

From what I've been told here, you are safe to increase his dosage. How much insulin is he on right now, and how long has he been on that dosage? And, how much does he weigh?

It seems to be the consensus here that increases can be done once a week, assuming a curve was also done.

I think being at the vet's can increase numbers for some dogs, so probably home testing is more accurate. For us, Winston's numbers didn't seem to be much affected at the vet's, but his 'low point' seemed delayed by a couple of hours. Not sure why.

The target range is around 150 as a low to 250 as a high, I believe. There may be some who would go lower, but it's a little risky. If you test a lot at home, that will let you keep good track of what is happening.

[jesse girl]

Re: curve questions

well the way i look at it is the more stable blood sugar is the easier it will be to make adjustments in the dose . i believe a 100 or less from the highest to the lowest blood sugar in a curve is excellent and quite stable which you are seeing in brunos curve . i think anything more than 200 things get a bit more unstable and unpredictable and you might want to work on that narrowing the spread

blood sugar from 100 to 200 is quite good many dont get to that point but 100 to 250 adequate

you will have days things can go allot higher and sometimes lower thats why we test everyday . i always test before giving insulin . you cant take it back once given . if your in the regulation process you may add at least one more test midway through after given insulin . you would like to do a curve once a week

you have to ignore oddball higher numbers and not adjust the dose to just one high number its patterns you adjust to within a complete curve and the adjustment is based on the lowest number in that curve

the only time you would make an adjustment to one number would be a low number and that maybe anything below a 100 during the regulation process and unsure if numbers might go lower

its not hard you stick to your protocols slow and steady wins the race

[amydunn19]

Re: curve questions

We generally say to wait a week since your last increase to do a curve and then make a small adjustment if needed and wait a week or 5 days at least to do another curve and before making more changes to dose or food. It is like a control test where you keep things the same. Now, if you have a flat curve with all pretty high numbers, I think you could bump the dose up a little. I don't advocate for more than one unit at a time. I would do spot checks more frequently at times when your dog is acting odd or if it has been a low point time wise previously.

The more you test, I want to caution you not to be reactive with insulin. It is tempting and scary when you see a high to jump in with insulin but it is just not a good choice. The other thing I see that can get you in trouble is to see a low number and overcorrect with food. I had to have a set plan with Maggie because she was the low number queen. Seeing LO on the meter can panic even the most seasoned caretaker. Large corrections with either food or insulin can put you on a roller coaster that could mess up your dog for days.

You seem to be doing great - I was such a hot mess with the testing. It took me forever to get comfortable doing it.

[Mom of Bruno]

Re: curve questions

"How much insulin is he on right now, and how long has he been on that dosage? And, how much does he weigh?"
He weighs between 90 and 95 pounds. He started on 10 units and the vet has been increasing by 2 a week for the last three weeks. Yesterday he increased by one unit which brings it up to 17 units twice a day.

Thank you for the suggestions, the support, and the benefit of your experience. It means so much to Bruno and me.

[Mom of Bruno]

More curve questions

Still looking for ideal dosage for Bruno. We are now at 20 units. So far, I observe a drop in the first 2 to 4 hours, then a rise back up to the initial value in the next 3 hours. The total difference from highest to lowest is about 150 or more. Am I right to assume that the lowest point should be at 6 hours ideally?And the range from highest to lowest should be under 100?
And the whole curve should be under 200 and above 100?

Also, Am I right to assume that it is best to start too low and increase dosage slowly?

[Raysaint]

Re: More curve questions

Firstly, what insulin are you using? NPH insulins start slowly then peak and then drop off. So usually the blood sugar goes high within the first 2 or 3 hours after eating, then drops after that as the insulin strengthens.

To drop the first 3 hours then increase could be a type of Somogy effect.
What does your dog weigh?

I'm sure the experienced people here will have some ideas. What does your vet say?

[MikeMurphy]

Re: More curve questions

Hi. What type of insulin is Bruno on? Can you post the times and results of his latest curve?

Every dog is different in how they process food and insulin, so the shape of the curve and BG low point varies from dog to dog. For example, my Lily's low point is around 9 hours after food and insulin.

Looking at your prior thread and assuming you're using Vestulin or Novolin N, it looks like your vet started Bruno at a conservative dose of 10 units for a 95 lb dog and is slowly increasing his dose, which is good.

My goal is to keep Lily's BG in the 100s and 200s all day long

[amydunn19]

Re: curve questions

I combined your two threads into one so people can see what has happened so far without searching. If you would like me to give this combined thread a new name so it is easier to find, let me know.

[Mom of Bruno]

Re: curve questions

Bruno last weighed 90.5 lbs. He is on Reilon novolin N.
After 19 units X2 for a week: 5....473
7....352
9....265
11....379
2:30....396
5....409

If I try in the first few days of the increased dosage, it drops to a minimum in the first two hours.

What's a Somogy effect?

[MikeMurphy]

Re: curve questions

Based on that curve, I'd say you are slowly making progress. Good job!

The normal starting dose for a 90.5 lb dog would be about 18 units or a little lower. You have plenty of room for increases of 1 unit and then evaluate with a curve after 5 to 7 days.

90.5 x .20 = 18.1

Insulin increases should be based on the lowest BG reading of the curve. Once your low number starts approaching 150, you know you are getting close to the proper insulin dose.

Somogyi rebound is one of the body's natural defense mechanisms to protect itself against hypoglycemia. It can occur when the blood glucose is too low, or if the blood glucose is above normal but drops too quickly. It is caused by an insulin overdose. That why it is best to go slowly with insulin increases so that you don't pass the proper dose.

http://www.caninediabetes.org/pdorg/somogyi.htm

[Gomeysmom]

Re: curve questions

I am going through the same thing with Gomey..She was started insulin on 4/26. We are using the walmart Novilin but have not gotten any "good" or consistent numbers. (lowest 260 once) We are going to the vet tomorrow and going to figure our next step..Gabapentin has not helped with her soreness. And gosh she HATES the taste! She makes the face a baby makes when they eat a lemon!! Tomorrow we will decide if acupuncture may help. I am also thinking about switching to Vetsulin as "they" say it may last longer...Gomey is 22lbs and she is up to 6 units every 12 hours but we are trying not to go to 7 units. Patience and consistency. Our vet has several diabetic patients and she knows there is not one recipe for every pet.