In dire need of recommendations with re-regulation

[Riliey and Mo]

the other reason he was hungry with reduced food is he might not have been regulated then. dogs act famished until their bg regulates and seeing swings in blood glucose changing amount or kind of food is what happens but tapers off in a week or so thats why we let food settle in

[jaycapz]

Riley and Mo - Before proceeding, I do need to mention we added a few pieces of extra kibble to dinner to try and correct dip around 8PM. Numbers from last night as requested below, I also did a couple of additional tests because I was nervous about the 6:30PM sudden drop. It is interesting to see such fluctuation over the short periods. I will mention he gets overly excited the hour before dinner and is much more hyper after dinner, not sure if thats a factor.

To your question about changing the test site, I have been mostly relying on his right ear for years. I switched to his left ear the past couple of months with the same results. Doing side by side comparison numbers are very close. I tried to go to the lip and he wasn't having it, we stopped attempting since he was not cooperating.

6PM: 113 (Fed/Insulin)
6:30PM: 79
7PM: 110
8PM: 82
830PM: 102
1030PM: 134
1130PM: 154

Yes: This I agree, he becomes nervous when his BG level drops to <80. He will stare at our hands, go to his food bowl, etc. If its a very temporary fluctuation he doesnt seem to budge. Last night for example, he was quiet, happy and stayed put.

the other reason he was hungry with reduced food is he might not have been regulated then. dogs act famished until their bg regulates and seeing swings in blood glucose changing amount or kind of food is what happens but tapers off in a week or so thats why we let food settle in

[jesse girl]

My Jesse could drop a 100 points chewing on a bone . It appears any heighten activity which boosts metabolism will cause insulin to work faster and with a stronger affect . It's kind of like taking a intermediate insulin and turning it into a fast acting .

[Riliey and Mo]

Riley and Mo - Before proceeding, I do need to mention we added a few pieces of extra kibble to dinner to try and correct dip around 8PM. Numbers from last night as requested below, I also did a couple of additional tests because I was nervous about the 6:30PM sudden drop. It is interesting to see such fluctuation over the short periods. I will mention he gets overly excited the hour before dinner and is much more hyper after dinner, not sure if thats a factor.

To your question about changing the test site, I have been mostly relying on his right ear for years. I switched to his left ear the past couple of months with the same results. Doing side by side comparison numbers are very close. I tried to go to the lip and he wasn't having it, we stopped attempting since he was not cooperating.

6PM: 113 (Fed/Insulin)
6:30PM: 79
7PM: 110
8PM: 82
830PM: 102
1030PM: 134
1130PM: 154

Yes: This I agree, he becomes nervous when his BG level drops to <80. He will stare at our hands, go to his food bowl, etc. If its a very temporary fluctuation he doesnt seem to budge. Last night for example, he was quiet, happy and stayed put.

looking like tight regulation and slowly fixing that dip

might give alittle more food to bring up the 6:30 dip more then reduce testing to only select times 6, 6:30, 8 for at least 3 days

let this change settle okay Jaycapz?
his numbers will change. this is normal.
when you see the numbers changing do nothing!!!

do not add food or up and down insulin

no more changes for at 3 days
remember we're trying to get you more comfortable and this is the route to take my friend

[jaycapz]

I will plan on incorporating the additional food going forward at night, while that settles for a couple of days. Theres the other big issue of day time ranges, we have honestly been afraid to leave the house too many times because of this situation. I'd love some ideas on how to manage/improve the day. As previously mentioned his daytime is very inconsistent, different starting points, the same amount of insulin and food has a 50/50 success rate. By success rate I also mean he doesn't blow up in the 300's+ and require a micro dose midday. We call it the 3 day problem, he will get into a rhythm for 2-3 days then blow up. We tried letting it ride on the day he ran high but the trend continued up and he needs a "reset".


4/14:
**6AM (breakfast/injection): 172 (11 3/4u) -- Oddly started a little lower, gave same 11 3/4 units and went much higher
8AM: 392 (went out for a quick pee, retested and was 244, meter issue?)
10AM: 267
12PM: 291 (micro dosed)
2PM: 149
4PM: 137

**6PM (Dinner/injection): 129 (11u)
8PM: 95
11PM: 142
--------------------------------------------

4/15:
**6AM (breakfast/injection): 154 (12u, Increased dose by 1/4u after an uptrend after 3 days with 11 3/4u)
8AM: 181
10AM: 243
12PM: 185
2PM: 167
4PM: 120

**6PM: (Dinner/injection): 113 (11u)
6PM: 113(Fed/Insulin)
8PM: 82
830PM: 102
1030PM: 134
1130PM: 154
--------------------------------------------

4/16:
**6AM (breakfast/injection): 163 (12u -- Stuck with 12u's again to retest. Numbers rocketed around noon.)
8AM: 205
10AM: 219
12PM: 353
1PM: 361 (micro dosed - I tried to be patient, waited to see if 12PM would come down)
2PM: 271
4PM: 189

**545PM (Dinner/injection): 148 (11u)

8PM: 124
11PM: 180
--------------------------------------------

4/17: *** Updating with this mornings situation as well, so you can see where I might be going wrong.

**6AM (breakfast/injection): 125 - 11 3/4u (Rare occurrence, hes been starting 160-200+ most mornings, being close to 150 night before w/ 11u would typically send him much higher in AM. We were afraid to give 12u again today, couple of weeks ago we gave 12u for 131 and he fell below 80 midday. Were we not supposed to pull back?)

8AM: 205
10AM: 219
--------------------------------------------

Am I being too over reactive with micro dosing when he breaks 300+? Since we hadn't dealt with these high ranges it's new to us, and I know Jesse just mentioned to focus on the bottom number not the highs. What is happening is he will give me a day like 4/15 for 2-3 days then suddenly increase drastically on the 3rd day. What should be my approach? Just let him rocket over 300-400 and assume he will just come back down and settle in, or keep increasing? We went from pro's with him to feeling dumb as rocks. Thank you all for your help here, I know your doing your best to guide me. I just want to keep him safe when we are not home, its like we're reliving covid lockdown a bit at times with him.

[jesse girl]

You are kind of like a insulin pump . I was like that in jesses first 6 months . The question is it helpful ? Adding any additional dose may create overlap . With such a small added dose it does appear to get a strong response .

The spikes in sugar like after injecting at 172 may have come off a much lower number earlier and when a possible rebound may have started . Once its started there can be a big spike . I think most swings are caused by this . Less about food induced spikes . Mostly just a hormonal response from the body and calming that affect and not triggering it is important but easier said than done

[Riliey and Mo]

when you add in his food do it am and pm every 12 hours.
same same same for 7 days
no changes
your chasing numbers so please let changes to his body take effect and let his body respond
patients is the key to regulation

[jaycapz]

You are kind of like a insulin pump . I was like that in jesses first 6 months . The question is it helpful ? Adding any additional dose may create overlap . With such a small added dose it does appear to get a strong response .

The spikes in sugar like after injecting at 172 may have come off a much lower number earlier and when a possible rebound may have started . Once its started there can be a big spike . I think most swings are caused by this . Less about food induced spikes . Mostly just a hormonal response from the body and calming that affect and not triggering it is important but easier said than done

jesse girl - I see what your saying, so should I follow what Riliey and Mo recommended for the evening and maybe test 30 minutes after food/injection in the AM to confirm whether this is some sort of rebound? Or some other way to confirm that you might recommend?

when you add in his food do it am and pm every 12 hours.
same same same for 7 days
no changes
your chasing numbers so please let changes to his body take effect and let his body respond
patients is the key to regulation

Riliey and Mo - Just to understand the first part about adding food every 12 hours, are you saying that if changes are made to the food. Do the changes for both AM and PM for that day? He receives a slightly different amount night/day right now. Just trying to make sure I understand and can follow appropriately. I do acknowledge we have been number chasing. A few months ago we tried only doing changes slowly every few days, letting one change settle, then we would see a sudden increase or decrease that caused us to back off or add more. To be honest, letting his range ride in the 300+ for a week scares me, it plays on my fears for his vision. But were saying thats ok and should be fine? I think I also need to confirm Jesse girl's point about rebound.... Maybe we are causing some of these spikes?

[Riliey and Mo]

yes your seeing higher and higher numbers from making changes during the day and everday
feed same amount same kind every 12 hours
his numbers will go higher or lower during the process change thats why we wait at least 3 days without any changes

[k9diabetes]

This is a crude approach, I know, but there's nothing wrong with letting his blood sugar run higher when you have to be away from home. Running a bit high for a day isn't the end of the world. It's the long-term highs that create problems.

If insulin dosing is too difficult to adjust you can give additional food, which has a smaller effect on blood sugar overall. Something quickly digestible and carby if the drop occurs soon after and something protein based if it occurs later. Something rapidly digestible can work well because it props up his blood sugar, which uses up insulin and can actually counteract a drop later on.

The same is true with the pepcid. You can counter lower blood sugar from the pepcid by supplementing his food in that meal to even things out.

Keep in mind too that inconsistency isn't necessarily a consequence of your actions. It can occur all on its own, especially in older pups with other things going on, such as inflammation. Our dog's insulin needs varied over periods of days to a week. We tested him before each meal and adjusted the insulin dose as needed. I've seen some dogs who went months on a dose (Rotties, I'm talking to you!) and then suddenly needed quite a bit more or less. Just the way they were built and/or their particular diabetes and other stuff going on.

Inconsistency can be something you learn to expect and live with! If the wobbles are just a day or two, they might not need adjusting.

Natalie

[jaycapz]

It's been a tough few weeks since I posted here, still trying to find a balance but hit some speed bumps. I lost my grandfather a couple of weeks ago, then had some other personal situations, to say we're exhausted is an understatement.

I tried going back to basics, I was giving the same amount of food night and day, his nighttime insulin requirements as previously mentioned are a bit less. With that being said, I tried sticking with 11 3/4 units day, 11units at night (which was somewhat working out). Since his requirements at night reduced after switching foods (due to IBD), its become very hard to adjust. His swings were wild by trying to remain with same dosages, start end points 100's-300+, etc. I had to go back to managing based on needs of the morning/night because of personal issues. We then hit another interesting speed bump, for a few days we experienced what felt like insulin resistance, the insulin duration wasn't there, during the day he was spiking, we would give 1/2u-1u doses and see it last 1-2 hours. I replaced the insulin, the issue was resolved for a few days then same issue resurfaced. For almost 9 years I've kept his insulin refrigerated after opening, I measured the frig temp over a few days and found it to be inconsistent in a range of 34-40 degrees, Novilin N insulin range is 36+, so I suspect the temp of fridge being an issue. So I am now keeping it on the counter per the instructions (under 77 degrees) until I figure out the fridge situation. Well, now we are seeing different response times and durations. The insulin appears to hit faster, so we had to make some adjustments, duration seems a bit better at times but inconsistent. So far none of the original insulin doses based on ranges we learned are working out, so it feels like starting over AGAIN. Months of data out the window.

k9diabetes /Natalie - I think I'm going to be stuck in the same boat now. Unfortunately, I am starting to feel like we'll just need to be flexible and adjust based him daily/weekly/etc needs. Its been months, and we just can't seem to find a common ground anymore. Unfortunately, his food is extremely high in carbs, any change at all seems to have some very unpredictable outcomes. For example, if we remove just 4-5 pieces of his food it could cause him to end 50+ lower in a single day. So we weigh food to the tenth place, spot on every time. Crazy! Appreciate the guidance, if you've read my thread I'm sure you've noticed I'm neurotic about his vision and other possible complications. I'm learning to be flexible, I'm accepting that some days he'll hang in the low to mid 200's, and I'm ok with 100-250 (with some days spiking a bit higher) if we can get him to stay there. I'm trying to only focus on where he starts/ends, not the journey in between.

Its been rough, I'm just hoping we can get back to his previously more stable evening situation. Previously we could easily adjust his night 11-11 1/4u to land him in a 150-200 range for morning. Now his night's a mess, we're back to trying to fix the 8PM dip which we previously fixed with food, it also seems we may need to offset timing of food and/or pull back insulin a bit. I'm not sure, just going through trial and error. I would gladly give days off my final moments on this earth to either have him manageable like before or cure it altogether, even if its just for a short time.

Thanks for letting me vent, I've written a novel here. Last night I woke up every 2 hours to check on him, trying to see where he swings, make sure simogy effect is not involved, etc. I'm feeling delusional. I may have mentioned, I have a kid on the way, shes due to be here in August and honestly terrified about how to leave him for long periods. I'm not sure what highs are OK for what duration anymore. Hoping I can make some progress, I still have some time. My girlfriends mom offered to stay with him when the time comes, so thats a relief, but we've yet to cover testing and shots and how it all works. So, its scary to leave his life in another's hands. My OCD and anxiety has me dreaming about needing to bring my pup to the hospital while I'm at a hospital with my child being delivered, mental, I know.

[Riliey and Mo]

goodday to you hope life things are settling in abit more for you
swings from 100 to 300 are not all bad. your going to see bumps in the road hear and there it's expected in life and normal for diabetes regulation. to give him 3 or 4 days in that range without any changes will help you. doing a curve and adjusting up or down half a unit should get you prepared for when the baby arrives eh!
like Natalie says if the wobbles are only a day or 2 he might not need adjusting!

[jaycapz]

One of the issues is when he swings high, he doesn't always come back down with the next dose. He'll go up and up, then sometimes if increasing after a few days its suddenly too much. Its almost like he needs a reset, which is how I ended up micro dosing or dosing each day based on where he starts.

The insulin (Novilin N) is acting differently since keeping it on the counter, the duration seems a little longer, and it looks like it might be hitting a little faster. I'm wondering if some prior issues were due to inconsistent fridge temps affecting the insulin the past few months, I'm really not sure. Even though I'm going to buy a new fridge end of month, I'm planning to leave the insulin out moving forward. Has anyone observed this before?

Also a different question, I used to prefill syringes for a few days in advanced when he was previously better regulated and keep them in the fridge. I'm planning to make a few prefilled syringes in case of emergency if a family member needs to care for him, and keep them out in an insulated jar. Mixed statements / recommendations online about doing this, but I'd assume its fine and same considerations for temp and light, etc.

[Riliey and Mo]

morning

you say his numbers go up and up like he needs a reset IMG_0187.jpg IMG_0211.jpg
heres a couple of charts to look at.
as long as the temp is okay then the syringes will be . i kept mine in the fridge, took them out warmed them up

[jaycapz]

Riliey and Mo The first picture for administration always confused me, he has typically had a mountain curve over the years and start/end point would be the nadir. So for example, breakfast/dinner might be 130-150 and mid-day peaks 225-250. I've suspected Somogyi in the past, but the curves or effect don't line up with the definition or examples. Its not sudden, so for example he may start end 130-160 range for 2-3 days, then he'll start creeping up to 200, then a few days more he'll be over 250. So after I let him creep up to 200+ after a few days, I increase dose and it may work fine to maintain him a day or two or its too much. If that makes sense?

Thanks for the input, I might just make a couple of syringes just in case then. I'm trying to reduce any potential error if/when someone needs to care for him if I need to suddenly head to the hospital and can't get back in time. Its hard enough to explain the rest of his routine to an outsider. I sure do miss his pup days, walk, feed, play, sleep. I can't believe its been nearly a decade of dealing with his diabetes, I forget what it was like to just have the simple life.