Kumbi died uexpectedly June 8 2010

[Patty]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

Maybe she needs to have a word with Mother Nature!

I think that Ladybug thinks I can control the weather!

Well, tomorrow morning I'm going to go outside and make up some kind of dance to make the rain stop! What do you think!

Well Linda, can one of the 2 of you do something about the 20 degree weather we are supposed to have tonight?
When it's cold, Ali hangs out inside sleeping...and that makes her bgs rise.

Patty

[CarolW]

Kumbi curving - Terrifying Threes!

Welll, my dear buddies, as you all are, I'll be back in a bit and byte to reply to your lovely posts.

Meantime, I'm curving Kumbi again today, to try to see better just WHERE I want to put his insulin dose. Yesterday morning - Mother's Day - I suddenly felt I wanted to bring him back up from the slightly-reduced dose I began this past Tuesday, 4 May, evening - from 7.5 iu of Novolin-NPH to 7.0 iu; then I raised it Wendesday morning, 5 May. to 7.25, determined to hold it there about a week. Purpose -if these fluctuating BGs ARE rebound, as I think they COULD be, to put the rebounding at least a little in check (no pun intended).

Then yesterday, with a high morning reading, I put it back up to 7.5 iu - and gave the same in the evening.

MOTHER! what ARE you DOING! Likely, that was a BAD IDEA!

Just look at these Terrifying Threes, on today's readings so far:


Monday, 10 May 2010; Kumbi BG curve;
Meter OneTouch Ultra2, Kumbi II
Weather: overcast, coolish; 8 degrees C - 46 degrees F
dripping drips from the sky, not soaking


06:30 - 23.7 mmol/L = 428 mg/dL (bad enough)
Meds and breakfast; 06:30
07:01 - 33.2 mmol/L = 599 mg/dL - EEEEEK!
Insulin - Novolin-NPH, 7.25 iu (keeping MYSELF in check)
*** Dropped Insulin dose from 7.5 to 7.25 ***
09:01 - 23.2 mmol/L = 418 mg/dL - hmm - roaring down
Walk - moderate pace, low excite; 09:19 - 09:54 (36 min)
11:00 - 13.8 mmol/L = 249 mg/dL - waterfall - glucose-fall?

Betcha anything he won't drop a LOT lower than that. Maybe down to 7 or so. NOT - I say, NOT - THREE!

Next test scheduled for 1 p.m,, after which, weather permitting, I'll walk Kumbi again, probably for around 30 minutes.

One possibility for some of these high readings is that Kumbi IS scarting up SOMETHING along the roadsides - hoped mostly berries, but, Linda and Ladybug, I DO watch him practically every step of the way; I can't always prevent him from grabbing something.

Kumbi seems to FEEL pretty good. Was negative for ketones (ketostix) just after 9 a.m. He's drinking considerably more water this MORNING than he's done in quite some time; usually his main drinking is evening, after his supper.

Mon, 10 May 2010 11:50:49 (PDT) - gonna snatch a nap!

[CarolW]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

I don't BELIEVE this! Yes, I do. Just like me. Can't see the nose RIGHT IN FRONT OF MY FACE! Well, gosh; Kumbi can see HIS nose - sort of - it sticks out far enough. Or he can smell it, or something.

Linda and Ladybug, you here? I have a new page dedicated to you two. Here I was, yesterday or the day before, commenting about that puppy milkbone and rising BGs - and all the while, here I was doing the same thing to Kumbi!

I'll eat my hat (Kumbi says, NOT MY PATIENT'S HAT) if I'm wrong about this, but I'll bet you anything it's Kumbi's afternoon snack sending his BGs soaring, evening!

So today, we change. I'll watch and see what's happening.

Patty, we are getting sort of similar temperature changes - quite steep, a bit like Kumbi's curves. Twenty Fahrenheit is COLD! That's about 6.6 degrees Celsius (we have Celsius here in Canada).

Hope nobody froze a toenail nor a paw last night!

Natalie, and Eileen, thanks so much for your suggestions about bypassing what might be unnecessary - expensive - tests!

I'd been thinking the same. We're scheduled for a repeat blood panel for next Tuesday - a week from today; we'll see how that goes. I'm betting Kumbi's liver values are improved. He feels so much better these days.

There remained the very puzzling soaring of Kumbi's glucose levels in the evening. Now, if I'd taken just ONE step back from my own charts, and actually LOOKED at them, with other than a Charting Eye - likely, I would have asked myself, much sooner: "Just what is going on at five in the afternoon?" Or, better, "Just what is going on a couple of hours earler - at THREE in the afternoon!

I think maybe those Terrifying Three numbers (in mmol/L) I got yesterday were trying to tell me something. Such as, "Look at THREE; look at THREE, you silly!"

So, today, it hit me in the face (which is now a lovely shade of red) - SNACK at three - does Kumbi need that? It seems, no, he doesn't!

So, now to reorganize Kumbi's treats, so he gets a bit of a treat instead of a snack, at three in the afternoon!

http://www.coherentdog.org/vek/kubgconsistent.php

I need a nap again - and we'll walk later - without a snack!

Tue, 11 May 2010 12:59:50 (PDT)

[Ladybug]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

Hi Carol!

Linda and Ladybug, you here? I have a new page dedicated to you two. Here I was, yesterday or the day before, commenting about that puppy milkbone and rising BGs - and all the while, here I was doing the same thing to Kumbi!

We're here tonight and fine as frog's hair - everything is perfect today! I would love to see the page, maybe send me the link!

But, Ladybug didn't have her Milk Bone treat yesterday....and look what happened! Then again, she didn't have it today and she's fine!

Who knows what lurks in the minds of diabetic dogs.......I bet they think of all kinds of schemes to get food, sweets, attention! But what it does to us human parents!!! AACK!!!

Linda/Ladybug

[CarolW]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

Hey, Linda! Remember it can take a day or two - or three - before things begin to settle after a change! I'm reminding MYSELF of that right now, too.

The link to the new page is near the end of my previous post; thought I'd point that out rather than repeating the link so soon!

The dedication to you and Ladybug is below the second chart on the page.

I'm taking a few extra readings today; Kumbi does NOT appreciate that, after so many Sticks yesterday! I gave him tiny amounts of his canned food, instead of soaked kibble, for treats, because I think the dry food REALLY sends his glucose levels up; the canned, much less so. Guess I'll find out! That is, assuming it was the kibble that was sending him soaring in the evenings! It could be at least partly that.

I'll report back, and catch you on your thread, too, where I'm keeping up reading.

Kumbi sends his love to you and Ladybug, and so do I!

Tue, 11 May 2010 16:18:45 (PDT)

[CarolW]

Re: Did I solve the evening soaring mystery?

Oh my doGNess!

Just have a look at Kumbi's evening soarings of BGs - typical since he went onto Chinese herbs - liver support stuff, on 1 April 2010:

http://www.coherentdog.org/vek/kubgconsistent.php

That was yesterday's curve.

Now, compare with today's reading - I only took five, as we didn't really need to keep bugging Kumbi all the time (his poor lip!) - but i took them at times when he's been soaring.

And what did we get?

This!

http://www.coherentdog.org/vek/kubgnokibble.php

We don't have that nasty soaring that shows in the rest of his April 2010 charts. We have only the typical food spike after his supper.

Good heavens! What a difference 13 kibbles make! Rather, their absence!

I'll continue keeping an eye (or meter) on things, as we go along, and report anything oddball.

Wed, 12 May 2010 22:29:36 (PDT)

[Patty]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

Wow, Carol. That's a pretty dramatic difference. Thank you were able to sleuth that out!
Patty

[CarolW]

Re: Discovering reasons for elevated BGs

Patty - I can tell you, I felt slow and stupid, when SUDDENLY I realized what was likely causing those evening soarings of Kumbi's BGs - actually, mostly since about the middle of April, since Kumbi had been on the meds that could change his insulin requirements.

It is SO dramatic on the charts - really hits you in the face - that similar shape with increasing slopes upward, from about five in the afternoon.

So, the temptation is to think, "What happens at five every day?" BUT - because it was kibble apparently causing the soaring, I have to allow time for the spike (especially when there's exercise in there, as there is!) - therefore, I next need to ask (guided by the charts) - "What happens at THREE every day?"

And because my computer Calendar program talks to me at three every afternoon - reminding me to give Kumbi his afternoon snack, and also, we either return from or leave for our afternoon walk around that time, that called my attention (FINALLY!) to -

Kumbi's afternoon snack!

From there, it's not difficult to figure out (this is still a guess, but I do think, likely) - the way Kumbi absorb the food - I could expect those spikes in the evening.

And I'd MISSED considering Tech Nyla's remark, "He's running out of insulin." Well, she was right on - I think!

If ever there was a demonstration of the usefulness of charts, I think this is one! Precisely because it hits you in the face!

Thu, 13 May 2010 06:49:06 (PDT)
Off to shoot Kumbi - but get his BG first!

[HugosMom]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

Hi Carol, now that you know what's causing the spike + Kumbi is running out of insulin at that time, what do you plan to do to compensate? Eliminate the snack or is it more complicated than that? Learning from your posts!

[CarolW]

Re: solutions to Kumbi's soarings; testing decisions

Hi Kirbi,

Once it struck me that very likely, it was the KIBBLE snack I'd been giving at three in the afternoon that set off Kumbi's evening soarings in BG levels (really, Tech Nyla had it right, I think - "he's running out of insulin") - it seemed to me to make sense to keep things VERY simple - and merely omit that kibble.

Kumbi is so accustomed to having a snack at that time that I substituted something I thought would barely raise his glucose levels, if at all - a tiny bit of his canned food. This food is sort of mushy, but not drippy, and I can take a bit of it and form it into tiny balls - a quarter teaspoon yields three tiny balls easily.

So that's what I gave him yesterday, instead of the kibble I'd been giving before at three in the afternoon.

And sure enough, we didn't have the soarings yesterday evening.

Today is more complex, because it's Hunt Day - my Senior Discount day on food and groceries - and Kumbi's Human DogDaddy is away camping. Kumbi can't be left alone at home, because I never had the opportunity to teach him to accept that. So I took him with me.

We went early, to avoid the heat of the day. I walked him first, and walked him at the vet's, too, where I took him to get his weight - aha; he's up to 8.9 Kg - a good thing - that's about 19.6 pounds.

We got home about three hours after leaving on the morning walk. This is a very stressful occasion for Kumbi, though mostly, I left him in the car, to avoid the fleas that tend to proliferate in town. (For some reason, he doesn't pick up fleas at the vet's!) I hate using flea poisons on Kumbi, though if I must, I use Advantage, which seems to do the job with minimal damage.

Kumbi has been having a LOT of pricks, and he's beginning to shake and tremble at Prick-time, so I'd like to eliminate any unnecessary ones. I've decided to use mostly pre-insulin-time in the morning - that's after food, where he gets quite a spike (mornings). But before his supper is a typical nadir-time for Kumbi, and likely, I'll continue to test right before feeding him in the evening. Then whether I add the pre-insulin check will depend on the pre-meal check. If the pre-meal check is fairly low, I'll probably need the pre-insulin check as well, to make sure I don't give him too much insulin.

I can count on a SMALL food-spike in the evenings, but oddly, it's not usually as much as he gets in the mornings. Or PERHAPS it's spread out over a much longer period in the evenings! I've never tracked Kumbi's glucose levels overnight. It would be interesting to do that, but I want to test as little as possible for now. Kumbi does stress lots at being tested! - even at home!

So, there's a LONG, rambly answer for you. Probably a main feature is, first, we never really know what's going on, without testing. Next, dogs vary - they are different from each other. Also, any one dog may vary from one day to the next, partly depending on how THEY see what's going on in their lives.

I think the best we can do is, do the testing we really need to do - consider the PURPOSE of the testing - am I trying to adjust the insulin dose? If so, I need a full curve. Or am I just trying to prevent hypo? If that, I need fewer tests, and it's a good idea to time them, for Kumbi, for late afternoon.

That single change of three-in-the-afternoon snack, from kibble to a tiny bit of canned, clearly makes a big difference to Kumbi's glucose levels, so I'll need to be watching, to make sure to keep his insulin dose well-adjusted (as far as possible).

In previous trial-and-error - and - from my vet, too - I learned to adjust in very small amounts, especially if RAISING doses. If glucose levels are dropping too far, it's safe to cut a dose by a fair bit, because going high won't kill the dog.

But I think I cut too much in the beginning of April (when he started with the Chinese herbs), and I ended up coming back up to his previous standard dose. Then later, I ended up cutting that back - by a QUARTER UNIT (twice a day).

Specifically, Kumbi had been on 7.5 iu of Novolin-NPH insulin since mid-January this year. After a week or so of adjusting too-much down, I came back up to 7.5, and then cut to 7.25, where, for the moment, I'm holding.

All this is enough to make us scratch our heads, isn't it!

I have one struggle for myself this evening. i really would like to know how low Kumbi goes right before his supper (fasting). His reading at three today was 10.2 mmol/L (184 mg/dL) - and I suspect he's going lower before his supper - how low, is the question, and when!

But today is absolutely not a typical day for Kumbi - he almost never accompanies me on Hunt Day. Going with me adds a great deal to his stress - doesn't matter if it's eu-stress (good stress, fun) or dis-stress (bad stress, or, no fun!) Both kinds of stress have the same physiological result - that is, elevations of stress-hormones such as cortisol.

What DOES matter is just one thing - how much insulin should I give Kumbi this evening? I'm absolutely NOT going to raise his dose, but I might reduce it, if he's unusually low. Probably not by much - a quarter unit, most likely.

I think I just decided to go ahead with the fasting test this evening - poor Kumbi - largely because his stresses were rather large today, and he had only bits of canned food as a snack - and we walked after that. I FEEL as though I want to know if he hits a nadir at fasting-time. So I guess I'll test at 6:30 p.m., and also pre-insulin, at 7 p.m. To make sure I don't OVERDOSE him with insulin.

Currently I'm giving 7.25 units, twice daily. In PRINCIPLE, it's best to hold that dose absolutely steady, as far as possible - the only exception would be to cut back to prevent hypo, or, if you have a very recent curve, you can adjust based on that curve. And we have a curve from three days ago.

I guess this evening, I'll be breaking my rule - ONLY test if I absolutely NEED TO KNOW! It's the pre-insulin test that matters.

If you read ALL THIS - you were very patient, and Vekkie offers you a Patience Hat,

http://www.coherentdog.org/tidberries4.php

as long as it's exactly the same as hers. It's too much work to make a different one!

Thu, 13 May 2010 17:23:20 (PDT)

[HugosMom]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

You always give me such great things to think about. You are right about the head-scratching! "Consider the PURPOSE of testing". That one comment helps. I find myself testing him a lot these days because I've seen some low numbers for him. It's become a bit of a crutch for me and he doesn't seem to mind. In fact, I swear he asks me to do it. He'll bang around in my kitchen shoving the step stool, nudging the recycling until something crashes, and always looking at me. It may be time to test or even time for his injection and he seems to let me know.

This last dose adjustment to get us closer to the numbers we want had his BGs all over the place. You were all so right about the 5 to 7 days AND about a smaller dose change when we got closer. I just didn't know exactly when that would be. I think I found it. I'll study his numbers to see if I can understand when his spikes are the way you know when Kumbi's are. His evening numbers go low (8 - 10 at the lowest) but then it's dinner time and they shoot right back up while I consider whether or not to lower his dose.

Hugo would not be impressed if I eliminated his afternoon snack and I am sometimes seeing higher numbers after that so that was partly the reason for the original question. I appreciate the detail! By seeing your thought process around it all helps me understand it much better and gets me thinking about things I might not have!

[CarolW]

Re: Kwali (ndd), Kumbi (dd) and me (Carol, ndh)

Hey, Kirbi! Our minds seem to run on similar tracks - dealing with rather excruciating detail! But, then, that's generally done on this forum, a little at a time - it's one reason the forum is so very, very helpful.

I'm amused and pleased that Hugo asks you to test! Kumbi would never do that!

I did do that extra test this evening, and glad I did.

Here are today's readings for a very unusual day for Kumbi (going with me on Hunt Day).

Thursday, 13 May 2010 (Hunt Day)

Meds and dry food - 06:30
07:00 - 27.3 mmol/L = 492 mg/dL
Insulin - Novolin-NPH, 7.25 iu, 07:00
Canned food - 07:00
15:00 - 10.2 mmol/L = 184 mg/dL
18:30 - 8.9 mmol/L = 160 mg/dL
Meds and dry food - 18:30
19:00 - 17.1 mmol/L = 308 mg/dL
Insulin - Novolin-NPH, 7.25 iu, 19:00
canned food, 19:00

No kibble treats or snacks given today.

No fasting reading this morning, so no indication of the morning food spike, though I find that spike is generally somewhere around 6 mmol/L, which would be about 108 mg/dL.

Look at that evening spike! - 8.2 mmol/L, or, about 148 mg/dL - in half an hour!

I held Kumbi's insulin dose at 7.25 iu (Novolin-NPH). Part of dealing with rapidly-changing BGs is exactly that, I think - holding everything else just as steady as possible.

By the way, it's the dry food - the kibble - that causes the spikes. The canned food doesn't.

Consistency, says my vet, is part of why and how Kumbi has generally done very well, despite these variations.

Kumbi may shoot up, but he doesn't STAY up very long; the insulin kicks in, and starts doing its job.

One day, rather, night - sometime when I haven't been constantly attacking Kumbi with lancets! - I might do checks through the night, though I doubt every two hours, though that would be useful.

Kumbi says to Hugo - you are a lucky dog! Great Dog-Mum you've got there! Well, mine is okay, too, even though I don't like Sticks.

I'm falling asleep at the keyboard again, so will likely retire shortly for the night! Kumbi is dozing on his favorite bed, and will surely join me before too long. I always stroke him on my way to bed, and generally, he follows me up onto Our Bed a few minutes later.

This is Day Two of no kibble-treats during the day; again, Kumbi didn't show that soaring from five p.m. with increasing slope through to insulin-time in the evening. I'll probably chart this; tomorrow; can't manage tonight; too sleepy.

Indeed, it looks as though that afternoon kibble-snack was the culprit for evening soarings of the sort Kumbi experienced recently.

Thu, 13 May 2010 20:56:39 (PDT)

[CarolW]

Re: Surprise BGs, Fri 14 May 2010, 15:00 ff

Yikes! Big surprise at the 15:00 (3 p.m.) BG test.

15:00 - 4.6 mmol/L = 83 mg/dL

I gave Kumbi a quarter teaspoon of his canned food, which is what I'm now giving (third day) instead of the ten soaked kibbles, along with another three I give after afternoon walks. Or, I USED TO. (I've also been doing the same after morning walks, omitting three soaked kibbles, and giving, instead, a quarter teaspoon of canned dog food.

I had no reason to suspect any problem with that reading, so didn't bother with a second one right away. Instead, I'm continuing taking readings at fairly close intervals. I opened my bottle of Karo - peeled off the cap - had bought a new one after not using one for three years and more!

So I'm measuring again

15:15 - 4.6 mmol/L = 83 mg/dL
Gave three soaked kibbles after this one.

and continuing:

15:30 - 4.8 mmol/L = 86 mg/dL

Starting up WHEW!

I think the kibbles are at work .Probably won't need the Karo corn syrup!

Tech Nyla says, no readings below 5.0 mmol/L (90 mg/dL), please. She says hypo level is 2.0 mmol/L (36 mg/dL).

I'm adding other readings I wasn't going to do today - one in five minutes, at 4 p.m., one at 5 p.m., and will continue at fasting (6:30 p.m.) and pre-insulin (7 p.m.).

Icky Pricky Kumbi! Kumbi says, NO! Icky Pricky MUMMY!

He seems fine. Dogs often do - till they collapse with hypo - there are, it's commonly said, few, if any real advanced warning signs - only the hypo event! NO, thanks! So far, Kumbi has never had a hypo, but he came nearly this close on 8 June. 2007.

Fri, 14 May 2010 15:57:56 (PDT)

[CarolW]

Surprise BGs update #1, from 16:00, 14 May 2010

Kumbi's BG reading at 4 p.m.:

16:02 - 5.4 mmol/L = 97 mg/dL

We're on the way up; I see no danger, though I'll be watching. I notified my vets. They are totally swamped today.

I'm not worried. I'm considering cutting Kumbi's insulin dose back to 7.0 units of Novolin-NPH, from his current (only for the last 10 days or so [since the evening of 4 May]) 7.25 units; before that, it was 7.5 units. Except that on 9 May, I gave him 7.5 units twice that day. Changed my mind again, and went back to 7.25.

Kumbi came off a 50-day course of Clavaseptin, the morning of Wed. 12 May. This could be affecting his BG levels - quite likely IS!

Add to that my change of food, in the sense that, three days ago, I stopped feeding 10 kibbles for an afternoon snack, as well as 3 kibbles after each of two walks a day. Instead, I've been feeding a quarter teaspoon of his canned dog food.

I think things are looking up; I just need to watch Kumbi's BG levels.

And adjust as needed, with insulin. I don't plan to go back to feeding kibbles for snacks.

Guess I'll have to buy more lancets and test strips, earlier than I'd planned. Gosh!

Fri, 14 May 2010 16:49:05 (PDT)
(Next tests due at 17:00 and 18:30.)

[peggy0]

Re: Surprise BGs update #1, from 16:00, 14 May 2010

Hi Carol

Forbins BGs dropped 3 days after his antibiotic was finished. While he was one them, I typically had to raise his dosage 10% so you're probably seeing that going on. Too bad we can't grow strip trees