In dire need of recommendations with re-regulation

[jaycapz]

Its been a while since I have navigated this forum. Jude is now 8+ years diabetic, hypothyroid and as of a few months ago was diagnosed with IBD as well. We had a really good run, he was like clock work, very well regulated. Now we are starting over and unfortunately limited on what foods we can choose. So this is where we really need some help, we have not had a good night sleep due to his late night BG drops. Exhausted and tired, feeling hopeless, I hope someone out there is willing to share a few suggestions.

He was originally on royal canine glycobalance dry food mixed with a blue buffalo canned food for years. He was good twice a day with about 11 units plus his food, he has a mountain curve and was consistent landing in the 80-130 range every 12 hours. Fast forward to now trying to re-regulate on new food, we have tried a few hydrolyzed dry foods mixed with hydrolyzed canned and his BG levels are all over the place. The hydrolyzed foods are mostly high in carbs (~60%), moderate protein (10-15%) and lower in fiber (5-8%) on average. So we bought Purina Gastroenteric High Fiber dry food, its about 48% carb, 24% protein and 21% in fiber. We are doing 3/4 cup of the hydro food and 1/3 cup of the new high fiber food. Its a delicate balance with his stomach, and increasing the new food will upset his stomach. We have see his numbers stabilize a bit thanks to adding in the new food. Now let me get into the struggle.

For the most part, the day time numbers are good and consistent. He slightly comes down a little lower than I would like at the end of the day, but its not too bad. The night time is our current nightmare scenario, his BG levels drop within the first 2-3 hours after meal and shot. This does not occur in the morning, it seems to be a big issue at night. Heres an example of yesterdays BG curve:

TIME - BG Reading (AlphaTrak 2)
7AM - 137 11 units NPH, Food
9 AM - 119
11 AM - 142
12 PM - 201
2 PM - 203
4 PM - 177
6 PM - 147
7 PM - 119 11 units NPH, Food

9 PM - 60 1 Tablespoon Karo Syrup
9 30 PM - 86
10 PM - 59 1 Tablespoon Karo Syrup
11 PM - 123
12 AM - 153
2 AM - 177
7 AM - 108 11 units NPH, Food
9 AM - 148


My only theories right now is that his metabolism slows at night, and the insulin is beating the food. No changes to his routine such as exercise. Is this a thing where I need a little more starch and protein at night? I need stomach sensitive safe foods though, thats also an issue. I've tried adjusting the insulin lower by .5 or a full unit at night with no luck.

As you could imagine, waking up at 2AM, 4AM, etc is taking a toll. I can't fail him now, we are lucky he still has his sight thanks to his tight regulation over the years, and I don't want to give up here and have him lose it now. I was always told to keep him under 250 if you want to keep his sight.

We are so desperate to get him back to a good spot, its robbing us of our sanity and breaking our hearts to think we might not make it. Really hoping someone out there has had luck being in similar shoes and can share some advice.


Thank you for reading,

Jason (Jude and Jess)

[jesse girl]

Overall the numbers are good except for that drop in the evening . You may be getting some overlap and you can give a bit less insulin for that evening shot . Start with maybe 10 units and go for a week with no changes .

You have had exceptional regulation so letting it float a bit higher is perfectly fine . 150 to 200 is still good . As dogs get older and maybe develope other challenges you have to be a bit more flexible and maybe allow the numbers to run a bit higher . You have done great with regulation

When my Jesse became older I backed off a bit . She lived 11 years being diabetic and running a bit higher did not shorten her lifespan and she did not pass from diabetes.

Jesse also had digestive issues and pinto beans helped to solve her issues .

[jaycapz]

Thanks, Jesse Girl. So I backed off 11 units twice daily, its too much. I tried 10 units for a few days and Jude ran high in the range of 300-450. I had to put an end to that experiment after about 3 days. As of this morning, I am now testing 10.5 units twice daily. If that fails, then I could try 10.5 units in the AM, 10 units in the PM but I don't feel confident with that since 10 units either time of day seems to end with him drifting higher after a couple of days.

I'll give these trials a few days each, but I'm really feeling stuck between a rock and a hard spot with this food situation. I truly believe its the issue, hes on 3/4c old (hydrolyzed) and 1/4c new (gastroenteric - diabetic and GI friendly) food. Since introducing the new purina gastro food his numbers have been a bit more stable. if I try to increase the new gastro food he starts to show some stomach issues (ironically - he really needs a hydrolyzed diet), so I dont want to push that to far. The hydro food is unpredictable, I believe its hydrolyzed soy isolate so as a protein it also comes with a huge amount of carbs. I can try increasing his fiber powder supplement again (from 1/8 TSP), but if i add more than 1/4 TSP each meal he gets stomach issues. The best I could try is removing a few nuggets of his old kibble so his body is getting more of the new, rather than simply increasing the overall amount. However, hes on the minimum amount of calories as I don't want him to lose more weight.

I'm fine giving up the idea of him being in the 90-130 range every 12 hours and peak of approx 250, I'd gladly settle for a range of 50 points higher across the board buts there seems to be no balance. Its either running high or low as he stays on a dose.

What baffles my mind more is how he would get into a rhythm with 11 units, numbers slowly stabilize, then every couple of days appear to need a little less insulin. Then as the insulin units drop, his BG numbers quickly rise exponentially. Part of the regulation process with him years ago, the dose/food worked or it didnt, I dont recall it being a slow adjusting situation. You get what you see within 24-48 hours given the insulin dose/food amount. Does the body really adjust in that way, or is it more like hitting the lotto when you hit on the right dosage. I don't know anymore!

If anxiety were a currency, I'd be the wealthiest guy alive.



Thanks again for your input, I really appreciate it.

Jason

[jesse girl]

Your welcome Jason . Mico dosing is another possibility . I could get quarter unit adjustments .

[jaycapz]

Our journey continues with some improvement but still trying to find our way. Jude seems to be tolerating the new food, so I increased him to a 50/50 mix of old and new food. I no longer have the night time dip, instead hes now coming in a bit too high for his morning meal. What happens is he is good through 2-3 meals, but then the 3rd meal his numbers jump. Its like he needs a "reset" back to 80-100, and we are ok again for 24-36 hours. Heres an example of a new curve/monitoring:

6PM 90 10.5Units/Meal
9 PM 109
11 PM 130
1 AM 135
3 AM 123

6 AM 105 10.5Units/Meal
8 AM 145
10 AM 190
12PM 125
2 PM 121
4 PM 135

6 PM 123 10.5Units/Meal
8 PM 189
10 PM 120
12 AM 130
3 AM 141

6 AM 189 10.5Units/Meal
8 AM 284
11 AM 194
12 PM 170
3 PM 166
4 PM 192
6 PM 201


His numbers were great with the new ratio of food, but after about 24 hours what you see in bold happens. His AM numbers very slowly start to creep up and then they eventually they go out of control. I am thinking about trying to increase the newer food even more, I tried adding 1/4 and 1/5 tsp more fiber to his meals with no change. I am not sure if there is a "settle in" period or something where I keep pulling him back into range and eventually he adjusts? I never had this with him, but is it something where a settle in period really happens? In the past, it all just clicked when I hit the right insulin/food for him.

I feel like I'm getting closer, but each time I get close he pulls away.

[jesse girl]

Looks really good to me . It can take quite a bit of time to settle with food and dosing. The key is your not in that low range in this batch of testing

[jaycapz]

Well, I gave it over a week and still struggling to get him to settle into the dosage/food. I tried switching things around a bit, no matter how I try moving things around theres a slightly different problem to solve.

Here is a curve from today, what I'm trying to solve for is the drop off between 3PM-6PM. His overnight numbers with the same dosage/food does not experience the same issues. I have limited his exercise, hes been consistent so I'm not sure why hes struggling to hang on. I've tried reducing his insulin and he goes sky high, I increase the food and I can't seem to get him consistent on the same or slightly higher dose of insulin.

Seems like the insulin is still working on him a bit too well between breakfast/dinner, are there any foods or supplements that I can add to extend food/sugar support? I'm really at a loss, I thought about adding chicken or another protein, not sure if additional fiber would be beneficial? I'm honestly at a loss, I'm not sure why the inconsistently.


6PM 146 - 10 1/4u (1oz Hydro Food/1.4oz Gastro/High Fiber Food)
8PM 146
10PM 106
12PM 154
2AM 184
4AM 150

6AM 141 - 10 1/4u (1oz Hydro Food/1.4oz Gastro/High Fiber Food)
9AM 257
11AM 217
1PM 224
2PM 150
4PM 92
5PM 87
6PM 61


Thank you again for all your input.

[jaycapz]

Just out of curiosity, has anyone mentioned pepcid messing with glucose levels? We have a theory. We only give pepcid during the day, which is when his numbers are most inconsistent. I looked online and there are studies showing H2 blockers and PPIs lower BG levels significantly, as much as 20-30% over the course of several hours. Today I have him pepcid at 1230pm, by 2pm he dropped allot. Tomorrow I'm going to cut out pepcid and re-retry. I can't seem to find anyone discussing this on the forum in past years.