In dire need of recommendations with re-regulation

[Riliey and Mo]

May 10
your giving the answers yourself blood sugar rises
start end points 100's-300+, etc. I had to go back to managing based on needs

• Insulin adjustments made very frequently, which does not give the patient time to equilibrate between doses
• bloodsugar slowly rises
• changing insulin dose frequently

May11
your seeing his blood glucose keep rising instead of lowering.

after that few days of creeping up i raised insulin ....instead of raising his insulin start dropping back wait a few days till it doesn't creep up
make sense?

[jaycapz]

I'm back after some more time and testing. Still struggling even after following the advice, maybe its my approach still and I appreciate everyones input and patience.

I'll share the start/end BG readings, happy to share the actual curves. Still having the same issue with his BG levels swinging high to low, even with taking a less frequent approach to adjusting his insulin. Difficult to settle into a single dose without needing adjustments after a few days. Heres my example from the past week:


5/27
Morning: 147 / 11.5u
Night: 101 / 11u

5/28
Morning: 157 / 11.5u
Night: 173 / 11u

5/29
Morning: 190 / 11.5u
Night: 183 / 11u

5/30
Morning: 283 / 12u
Night: 224 / 11.5u *** This dose has produced different results. Either drops him closer to 100, or keeps him level around 200. Very inconsistent.

6/1
Morning: 124 / 11.5
Night: 111 / 11u


Heres another example from the prior week where the same morning dose produced wildly different outcomes:

5/20
Morning: 151 / 11.5u
Night: 108 / 11u

5/21
Morning: 137 / 11.5u
Night: 333 *** No idea why he went sky high. I checked him at 10am and was already very high to start the day. This has happen a few times over the past few weeks.



It's probably my inability to identify the right way to step up the dose after a few days, maybe i'm just terrible at following directions. The same dose morning could see him drop 50+ or triple by dinner. A half unit increase like today (6/2) could see him drop by 50 or even 100 points at end of day, and other times he goes higher, so its a bit concerning whether i'm moving slow or fast. Also I'm having issues keeping the night in lockstep with the day. Nighttime small insulin changes have been effect, although not well represented in my examples, 1/4 unit extra at night can drop him by 50+ points for breakfast.

As a note, maybe I failed to mention that hes sensitive to higher BG's. When he spikes to 300+ or allowing him to run higher for a couple of days, his stomach issues (IBD) act up, he gets hot, pants and just generally uncomfortable. So, another added joy of trying to slowly regulate him, I did not have this issue 9 years ago when I was able to get him regulated (pre-IBD and new food).

We had a couple of days where he was about 130-150 in the morning and gave the 11.5u, at dinner he ended way too low (75-85). Yet other days he could end in a same or higher place.

We love our 16 yr old boy, but he's really worn us down over the past several months. Baby will be here in a couple of months, can't state enough how nervous I am about leaving him with my girlfriends mom who we are first training on how to test him. I plan to have her mom call me with his numbers and i'll have to direct her on the insulin amount if we can't figure this out. Not the greatest quality of life for us, but we do what we can for what time we have with him.

[jaycapz]

Hi Riliey and Mo , jesse girl

I realize my last post was a bit heavy, and honestly we are not optimistic of ever getting back into a real groove. We retried the recommended approach again, same dose for 3+ days and had even wilder outcomes. This time he actually took a nose dive on a couple of days, and what we figured out it was due to a change in his routine and small changes in his activity on those days.

6/7 - Normal Activity, slept most of the day.
Morning: 158 / 11.5u
Night: 133 / 11u

6/8 - High Activity
Morning: 178 / 11.5u
Night: 88 *** Gave 1 TSP Honey, delayed food for 15 minutes. After 15 minutes he was 122, gave an 11u dose. Retested starting 2 hours later, followed normal/numbers for the night.


We both work from home. Jude has a routine where he wants to go up to the office to sleep in his bed after we eat breakfast where he sleeps for most of the day. The office is being repurposed as a nursey, so (6/8) we left him downstairs in our living room while we worked. He did a bunch of pacing earlier on, he refused to settle down on the couch or in his downstairs bed. Hes a creature of habit and is also highly co-dependent, he wants to be up our behinds and in the same rooms we are in. This all started with Covid. We saw the same issue of numbers tanking a day last weekend and didnt put it together until we saw it again this past weekend. It seems even a couple of extra trips up our stairs is enough to impact his glucose levels.

His levels are already a bit erratic at times, trying to account for his activity level is going to make it impossible. At this point, we are considering our options because we just can't seem to get there. I believe its a combination of his age, his body chemistry, his anxiety and most importantly the highly digestible hydrolyzed food that we are stuck with due to his IBD (which destroyed his perfect regulation). We had a very emotional discussion this weekend, managing him has become a full time job, and its put a lot of stress on us during this pregnancy. We feel our only options are to let him run much higher or consider a much harder decision, which we really don't want to do.

Honestly, I just don't feel as though I can keep him safe, we spoke to another vet during the week. They offered nothing, only again, pick the disease to manage. Hes 16 years old, no other major health issues and we know time is not on his side. My girlfriend is getting an elective c-section first week of august, she has back issues so she went with the section, the good news is that its planned and not hours of labor. Her mom will be here to help out, she offered to watch Jude and test him if needed the day of the procedure. She is willing to give injections as well. We have to train her and see if shes able, testing is not easy for everyone (as we all know). I only see letting him run higher as best option by cutting the insulin back a bit. My girlfriend will most likely be in the hospital for 2+ days, it will all fall to me, so I'm trying to keep him in a safe range while not losing my mind and being useful to her. It will be a tough 72 hour period. The hospital is 25 min away, the day the child is born is my top priority. Once she is here, I will come and go as much as I can.

He really does not have a middle ground, its either run average of 100-200 or miss and run 300+. Then it escalates from there and a chore to get him back on track. I have in back of my mind that running higher will make him ill, so it continues to give me anxiety over the situation.

I'm not sure what advice I'm looking for at this point, but I do appreciate everyone's time in reading my long winded updates.

[jesse girl]

The levels you posted are not at a dangerous level . The 88 more in reality is probably a bit higher . I have seen a tiny amount of dogs get to a hypoglycemic range . My Jesse tested in the 20s and did not go hypo . So it's rare if a dog is not heavily overdosed .

With my Jesse she was tired of testing in her latter life so I accommodated her . So her last 4 years were far more relaxed . I would still test her on occasion but it was minimal and she did just fine .

You have to decide what you want . I think you don't have to let your pup go as a option but you maybe need to pull back on testing . Honey seems to work ok with the digestive issues so you figure a time of day to give maybe everyday . My Jesse enjoyed honey .

It's maybe time to give your household a break and let go a bit

[jaycapz]

jesse girl Jude has actually had a hypo event on a couple of occasions around 8-9PM the last few months, some of our first in several years. Same dose, same starting BG range, but the insulin just hit differently on those nights We really don't know for sure why, but we started to suspect on days hes much more active before dinner. Not sure if its his numbers are still dropping due to activity, or his activity is speeding up the action of the insulin, or maybe both. We thought we solved for the 8PM dip by waiting about 10 minutes post feeding, but the last couple of nights suddenly we are back in the same boat. Yesterday morning he started about 160, we provided him the same 11.5u and he started running low around 2PM. Hes normally about 150-180 at 2PM, yesterday he fell to 100, then at 4PM he was down to 80 (normally 130-160) based on last curves. Then he continued the old trend of dipping at 8PM and needed a little honey, his activity level yesterday was normal. So, I can't blame activity for yesterday, it seems like the insulin is hitting differently. We switched out the insulin vial this morning (its about 3 weeks old), even though I would expect the insulin to be less effective (not more), I want to try to start eliminating possibilities. He ran a bit higher this morning (259) - probably due to our intervention last night, so we gave him a 12.5u dose for morning to bring him back within 150'sih based on past experience. If he comes in much lower than expected, then we are just going to have to start pulling back the dose.

He's not protesting testing thankfully, but I am sure he does not enjoy it. We do not want to let him go, but we have to be able to manage him a bit better. We do want to pull back, because this is just not sustainable any longer. If I can ask a couple of questions, you know my concerns about being blind, DKA, etc. I know you mentioned your girl kept her sight, and clearly you did an amazing job since she lived to a nice old age. In the last 4 years, what type of numbers did she have?

I've seen resources online say glucose over 250 mg generates the sorbitol that impacts the eye lens, and some of this all comes down to the dogs genetics if they get cataracts at all. I'm just trying to convince myself that if he were to say stay in the 200-300 range, I'm not going to cause him harm. For the DKA, you had mentioned and based on my own research, a dog may need to be in the 400+ range for a bit longer than hours to be in danger. If we had to pull back on insulin a day because we need to make a pediatrician appointment, I want to know that if he soars to 300+ for a few hours, I'm not leaving him in danger.

[jesse girl]

How do you describe a hypoglycemic event ? What symptoms did you see like seizures ? If you get to that point the dose is to much . Like I indicated . Usually a dog that has a hypoglycemic event is overdosed . Your priorities are in the wrong place .

Jesse regulation generally was 100 to 250 range . She had ice cream and some treats on occasion her last few years . She had a Carby milk bone everyday .

Eyesight is a bit of a role of the dice . Jesse had very high blood sugar in the beginning and struggled for months and did not succumb to cataract blindness . There must have been a reason but we have seen dogs overnight go blind .

Yes I wanted Jesse to keep her sight but not at risking worse and in the end tight regulation wasn't needed in her case .

There is much more going on biologically that we just aren't aware of . Her seizures from epilepsy ended those last 4 years which was a gift . Very unusual for epilepsy to go into remission with grand mal type eoelesy . It may have led to her dementia in the end from all the seizures she had .

I to tried to analyze and place a reason for things but realized most of it is a guess and many times what I believed wasn't correct . To say this caused this or that in the end we just don't know . Your dog has had a very attentive caretaker and you do it out of love but you two may need to find a little peace and relax things a bit .

[jaycapz]

The last hypo event was after a very active night, theres about 16 steps to go to the second floor. Jude made a few trips up/down the stairs because he was a little hyper and also curious as to what my girlfriend was doing upstairs. He gets antsy at night when she takes too long to come back down for what we now call couch time, where we settle in and watch TV for a couple of hours before bed. That night, once he settled down on the couch, his head started bobbing and he appeared shaky so I tested him. The meter registered somewhere in the high 50's/low 60's (I can't recall exact). For that time of night when it occurred would be one of his lower points, he would normally be anywhere from 120-150 on a more mellow night. We now have a small gate to block the stairs to block that behavior. A prior instance would be his legs slipping out from beneath him and the head bobbing like jitters. For the amount of insulin and time of night, he could be anywhere from 110-150. He has a sort of squiggly curve at night, he hits his lows around 8-9PM and then another smaller dip sometime between 2-3AM. The timing of the first dip is not great because its when hes most active. What we found is if we offset the insulin by 10 min after hes done eating, his dip occurs closer to 9PM or later, and bottom is higher (for example last night was 160). We didnt see such BG swings on his old food in 8+ years while he was on it, and his activity level was much greater. The food is looks like kix cereal, feels like corn puffs, its basically 60% simple carbs which probably burn rapidly.

You really went through so much with Jesse but I'm glad you found a manageable end with her. Seizures are hard, I had a really sweet cane corso pup with epilepsy and unfortunately we had to let her go before she turned 6. Medications were not working, and her quality of life was very poor. I give you a lot of credit. I just said the same yesterday about over analyzing, I over analyze what might be the cause for things and have to stop and just accept it is what it is.

I accept tight regulation is not possible in his case, not on this food and no other food works for him. I am also trying to accept that we need to let him run higher to both keep him safe and keep our sanity. If we can get him in the range of 150-250 for most of the day, i'll be very happy, but I do struggle with letting him run in the 300+ range. I sort of believe if he was going to be blind, it would have happen regardless of good regulation over the first 8 years. We spoke last night about this and said, if he has to go blind then maybe we say we did our best and its whats meant to be. We are starting to experiment with pulling back on the insulin a bit. The issue has been that a small change has big results. If we pull back a small 1/4u, instead of starting/ending 100-150 he may end over 250 or just keep going up and not come down. However, we obviously want him to be safe and if it takes being in the higher range then so be it at 16 years old. Our hands might be forced with a child becoming the priority soon.

Part of the issue is that we don't believe we can get to a single dose. His day/night time needs are different, so he already needs about 1/2u less at night. I don't mind needing maybe 2 different doses for morning or night to counter slightly higher/lower days/nights. We are just struggling to get there.


"Your priorities are in the wrong place ." Which priorities? Sorry, I think I know what you are referring to but just confirming.

[jesse girl]

What I suggested is seemingly prioritizing sight over low blood sugar .

Now this seems to be quite common with caretakers of the disease . You can go on many threads where it was more important to get higher numbers lower over lower numbers higher and I was guilty of this . I believe like you we place sight as a very important sense and prioritize that .

It's possible the dose you are giving is using up most reserves of glucose and your pup just sits on the edge . If your at a point where you don't have any room like going up the stairs before a low event than it appears there are little to no reserves left .

My theory is lowering the dose allows those reserves to increase and with such a battle from the body from going to low that increased reserves of glucose is able to make a impact and leave a dog higher .

My thoughts many tightly controlled dogs are overdosed to a certain degree . Probably maybe moving a bit to quickly in dosing or over reacting in response to higher numbers going past what was needed . By doing so with the higher numbers you are working on going after the reserve glucose and overwhelming that . Now that may work ok but if the body is underserved like changing a diet that can get you into problems . This is just a theory of mine . There is no way to identify where glucose comes from .

Early in Jesses process the pull was to go higher with the dose and that included the vet . Up to 6 units a day which was a dose that was to much for her . The vet demanded to stay at that elevated dose which in this diabetic dog world was not large but jesses needed less . As I suggested I think we can end up at a higher dose and the body can compensate with reserves but if that system is Interrupted the only safety net is catching that event by the caretaker through testing and or being symptomatic.

Once going past a dose that the body finds acceptable it can be very difficult finding your way back . As you said small doses lower leaves your dog at a higher range as more reserves are left to fight back to the strength of injected insulin . It's possible your pup would do better at say 7 units but being such a long time at a higher dose it maybe difficult to get the body to accept the lower dose and you could not handle leaving your dog higher for a dose to maybe settle with no guarantees

Line I suggested you can be a type of glucose pump giving honey at particular times in the day getting a glucose bump so to speak . Food is not going to work with the digestive issues . You know those low points and give it automatically whether it's needed or not but of course that still adds more complexity to the equation . With a new baby coming that's going to create more anxiety for the pup and that could further create downward pressure on glucose . You don't have many choices . For Jesse I finally accepted that a low blood sugar event was not acceptable . My daughter had a friend who was diabetic and died while sleeping . So sad . Don't know the circumstances but something was missed . You have done a fantastic job and put in allot of hard work . You are the expert of your dogs diabetes and when you reach that level there aren't many places to turn for answers . As they say it's lonely at the top .

[jaycapz]

That is a really interesting theory (glycogen stores), I starting doing a little research about glycogen stores and replenishment. I did some past testing to understand the impacts of his activity and how much his BG levels are impacted. After he goes roaming the first floor, and comes up the stairs I would see his BG levels drop by about 20-40 points on average (giving meter accuracy some credit). I would retest him 30 minutes later to find that he was nearly back to the same level, this is more so the case during the day but at night he stays down longer. Maybe this is part of the theory of the body using reserves to counter sudden drops.

We are very guilty of prioritizing sight and managing highs over lows, it was something that was very do-able before the IBD. I am as stubborn as the dog at times, and teaching an old dog new tricks, well it applies to humans too. We had a few days of sudden lows day/night, and since then his insulin needs have decreased a little bit. Interestingly by the exact same amount night/day. We slightly pulled back on the insulin and trying to establish a new baseline, its only a small pull back just to let his numbers run up a little bit. We'll try to stick it out a few days and see where his numbers go, if lower we pull back a bit more, if higher we will try to resist the urge to dose him (which we have not done in over a week - instead modified dose at meal time). This was the original plan, but suddenly out of left field even with the pull back his insulin needs decreased, maybe it has to do the with a shift in glycogen reserves, could be weather, or just because it was a Monday. It is going to be difficult to have him settle into something new after all we have done, but maybe we can work it in reverse order. Where we would normally increase the dose when beginning to regulate, maybe decreasing to let him adjust could work just as well? I'm not sure, it was an idea and not sure if it has been done. Hopefully its not too late to find a balance before the kid makes her debut.

I am very sorry about your daughters friend, that is really terrible but I hear you loud and clear. We do agree that with a baby coming into the house he will most likely experience some anxiety that will again impact his numbers. We also need a break from this unhealthy cycle we are in, its not easy!

We were doing a fantastic job the first 8 years of this disease, the past several months or so not so much. Probably have done him a disservice with failing to see it for what it is, as they say the road to hell is paved with good intentions.

I'm not much the religious type, but last week I printed the serenity prayer and mounted it to my office desk as a reminder. The key in that ".... accept the things I cannot change, the courage to change the things I can... and wisdom to know the difference". All of which requires some patience and strength, talk about reserves being depleted.

Thank you again for taking the time to reply, exchange ideas and try to ground me. This forum was such a huge part of our journey earlier on, and here I am so many years later...

[jesse girl]

Yeah I call it working regulation in reverse lowering the dose . The strategy is the same raising . You try to convince the body of accepting the new reality . My Jesses body would only accept a certain amount of insulin at one time so I had to give her 3:doses . It's amazing how you can develope strategies if you put the work into it .

It's interesting I was very much like you that Jesse was going to stay in a tight range and then a switch went off in my head latter in her life . I think I realized we were on the backside of her life . She was such a a good girl allowing me to test her endlessly . I had a epiphany looking into her beautiful eyes and I said it's time to relax a bit and smell the flowers . It was nice for both of us . Stop doing curves completely . Only tested at shot tine and sometimes not even then when I new she is usually be higher at that time . Jesses dose was quite small . I think was 9 units total for the day .

You have done an amazing job with your pup beating the odds by a longshot on many levels . You do it out of love as we all have done . I have changed many things in my life to improve who I am and be a better person . Jesse helped to make me that better person and I am eternally grateful to her . I believe her getting diabetes was to teach me how to be healthier in my life and it maybe why I am talking you today . It's interesting to look more deeply in the intricacies of life and finding the real meaning .

Enjoy your your new addition to your family . It's such a beautiful time . Learn to relax a bit and smell the flowers and enjoy the moments . You are a good person and always remember that . You will have good and not so good times but the difficult ones can make you stronger if you don't succumb to them

[Riliey and Mo]

IMG_0212.jpg
i got this t share its up on my bedroom wall

[jaycapz]

jesse girl Riliey and Mo Hope you are both doing well. So, we tried backing off a bit and coincidentally his levels were playing a bit nicer and found day/night was settling into the same dose about 70-80% of the time. After about 2 weeks he imploded for no good reason. We noticed onset of insulin was taking longer, duration was becoming shorter over the course of a week. Then suddenly it felt like insulin resistance, he did not want to come down from 250-400 range (where he would normally be 150-250). In the past, 1/2u off schedule dose would drop him about 50-100 points and put him back in range by end of day. Over the course of 3 days, the 1/2u had a small effect, it would drop him or maintain him for a couple of hours. The only observation we made was his stomach was not great the week prior, we gave him pepto 1/4 the recommended dose a every night/or other night for a week while his stomach was upset. I read some literature that states pepto has a terminal half life of 3 weeks and accumulates quickly in the liver, but it's such a small amount that i can't give that real thought.

On the 4th day we caved and brought him to the Vet. He did a bunch of bloodwork and found nothing obvious. He's had elevated liver enzymes for a decade, not bad enough to warrant taking action. Kidney/BUN level was 1 point over the threshold, but it was hot and we waited to be seen so I am sure he was dehydrated, nothing to do there either. The only other level that was a bit elevated was his thyroid, hes hypothyroid and on levothyroxine for 9+ years. T4 was 3.4 / 4 (do not recall TSH) but overall slightly on the higher side. He was checked 6 months ago and his levels were 2.4 / 4 on the T4, so we are going to adjust that down a little bit. Hes now on .3mg a day (split pill, so .15mg twice daily). A while back he was on .1mg twice daily but it was not enough, I feel like we needed a middle ground. So my Vet recommended .15mg morning and .1mg night, because theres no other way to make .25mg work with current available thyro-tab dosing. I dont like lop-sided dose but my Vet said it shoudn't matter, focus on the daily dose not the individual dose. Hopefully it won't cause issues at one point of the day vs another. My Vet wasn't pushing for the adjustment since hes in the range but a tad high. I've noticed Jude is a bit more anxious, and ZERO tolerance for the heat, he has been panting a bit more than normal (which we blamed the hot summer). Weight is stable, drinking and urination is the same, but I feel like a small change could help him. Hopefully it doesnt throw his metabolism out of wack.

Overall the Vet gave him a clean bill of health and said, "he still has some mileage left... hes in a good shape.." as he was jumping around the office acting like a young pup. He was finally diagnosed with immature cataracts, for years it was nuclear sclerosis but I think the past year has taken its toll with inability to regulate properly (or maybe its finally age catching up). Although, we've mostly achieved 150-250 range more than half most days now. Hes like "old dog", and "i'm astonished he still has his sight". I know we are lucky, he hasnt struggled with sight yet, hes too high anxiety to lose it and so are we lol. Seeing more gray in his eyes makes me sad.

Anyway, Just came back to share my latest and greatest. The baby is due in 3 weeks, and I'm more freaked out than ever. My girlfriends mom will stay with Jude while we are at the hospital, I trained her on his routine but I can tell shes a bit apprehensive. She struggles with the testing, and remembering all the small bits. Its hard to give up control. We are hoping hes in a good spot when we go in, and all works itself out.

[jesse girl]

A uneventful update which is what you want to see . I think the most important part iis your pup is in good spirits

Try to make it as easy as you can for the mom . Maybe less testing can be worked into the schedule since your in a stable place . Hope you and your partner have a uneventful birth of your child .

[jaycapz]

Yea, he's in great spirits but we are always living on the edge with him lol. We decreased his levothyroxine since his T4 and TSH was a little high, and over the past week we are seeing his insulin requirements increase. I asked my vet if this might be a possible side effect, he really wasn't sure but could be. Researching online I could not find a direct correlation, seems like it could go either way. We're also seeing his BG numbers swing quite a bit now, could be a result of thyroid levels adjusting. Last week for example, mornings between 120-150 we would give 11.5u and he would end around 200, mid day he would peak around 200-250. Yesterday morning 150, gave same 11.5u and by noon he was 380 and rising (we had to intervene).

I guess I'll try to go on a search for other members who made changes to their pups meds, I'm curious if this is just him or an expected side effect. Its only been a week and from what i can tell, hes going to need another 1/2u on average adjustment. Feels like a lot of insulin for his size, this would mean approx 12u for a 24-25lb dog.

[jesse girl]

I think it's just difficult for you not to be reactionary . I would not be concerned with a bit elevated unless it's a trend . Remember it's the low numbers is the danger . Also raising can lead to a rebound affect and can lead to elevated numbers . It's such a balance and staying consistent so the body can adapt