Patty's Ali - my precious, beautiful angel

[eyelostit]

Re: Update on Patty's Ali

Congratulations !!! Good Job

[Patty]

Re: Update on Patty's Ali

Just getting back to the board after a busy day...Thanks everyone!

[Patty]

Re: Update on Patty's Ali

Hi all,
Sometimes this girl changes so much, it's hard to sum it all up! We get good numbers like I posted in April, then it's like she starts to process whatever I've added more efficiently and she's back to dropping or running high preshot from the carb I've added.

This has happened with pumpkin, blueberries, sweet potato, pulverized carrots, green beans, banana, white rice, and mango. (She did not tolerate buckwheat or oatmeal - very itchy) I took out the mango and she resisted the change and gave me a few great days then started dropping again and bouncing back up so I went to rice, but when I added enough to keep her level in the middle, she started going high preshot.

I just added the mango back in thinking I'd try a rotation of 3 days mango, 2 days rice and back to mango, using the way she processes in her favor. I didn't get that far and she threw me for a loop.

I know Natalie had brought up testing for Cushings a while back and I'd looked into the adrenal panel due to her itchy vulvar area. I even called and spoke with Dr. Fecteau from UTK on the phone. But we held off because the itchy, inflamed area was not an issue like it had been and she doesn't have any signs of cushings other than wobbling numbers. Her numbers also don't continually climb. So that went on the back burner.

I truly believe it's a combination of the raw/low carb diet with the N insulin and her digestive system (curve is just too deep and I can't find something her allergies tolerate that seems to work in keeping her level). I've researched basal insulins for 8 months now. Lantus seems our best choice as Ali often responds to even 1/8u change. Levemir would just be too strong for her I think.

My vet here is willing to help us give it a try, perhaps next week. Hubby is away until Tues then leaves again the first part of July so I'd love to have him around to help if I switch. I have to admit Lantus' reputation for being unpredictable has made me hesitant but I believe I'm ready to try something new.

Ali still has her vision. I really want to preserve that and don't want to run her too high in this quest. But feel with her diet, and as well as she's doing allergy-wise on it, I owe it to her to see if we can find a gentler curve and keep the food.

Ali's typical schedule:
6:15a - up and out to potty
6:30a - food/insulin
6:45a-9:30a - sleeps but I get her up twice to go out or she rises too much. If she doesn't rest, she sometimes drops like a rock without rising hardly at all.
9:30a - 2nd meal (occasionally because of her wobble I will test and wait an hour to feed)
9:30-10:30a - hangs out inside let 2nd meal settle
10:30a - open dog door free access in/out when I'm home
2:30p - playtime, catch w/ball or bumper (no extreme running going on here but pretty active)
3:00p - she often comes inside and naps for an hour sometime between 3-5p but not always
6:30p - food/insulin
6:45p-9:30p - sleeps, up twice to go out
9:30p - last meal
10:30p - bed, sleeps all night

She is currently on 8 ½ - 8 ¾ u N (she varies somewhere between 8u and 9u over time – although 9 is usually just a bump to get her back into range and too strong to stay there). When she was on 8 ¼, I was thinking of starting her out at 6u of Lantus. I don’t want to start too low but want to be safe. Backing off 20% of her current dose of N would be at 6.8 - 7u of Lantus right now. What do you all think?

Also, would I need to start injecting in a different location? I know Lantus cannot be mixed with anything or used in the same syringe as another insulin. What about location of shot where N has been injected?

Ali gets "thick" areas where I inject and I rotate her injections periodically. We started with her scruff when I was first taught, moved down both sides above her shoulder blade area, to behind her shoulder blade but above the arm pit. I'm now using the rib cage behind the shoulder blade and arm pit area. My vet also told me it's not uncommon to develop antibodies in the area of injections.

I wrote this a couple of days ago and hadn't posted it yet...since then I've seen a few huge rises after her 1st meal that I've determined were due to absorption issues. Once I moved slightly to a "cleaner" injection site, she started dropping again. At this point, I may need to back off her insulin a hair. I'll post some of her recent numbers.

I know it's unconventional, but I've started adding the smallest amount of honey (like barely even a dot to 1 small drop, depending on her bg) to her 2nd meal and it seems to keep her curve from going too deep and allowed me to keep her preshot numbers in good range. Now I'm trying to weigh the pros and cons to NPH vs. Lantus. She really is so fragile on N due to her diet but we finally have some good numbers sticking around for more than 3 days at a time.

These are not full curves just spot checks and testing before her meals to figure her out. She does rise with her food/insulin meals and when things go well, returns to fasting 3 hours later - I just haven't tested the highs here.

6/15 (example of day with decreased insulin absorption)
180 - 6:27a food (4.75oz)/insulin 8 3/4
302 - 9:40a had been out twice, took her out to play catch to lower bg
239 - 11:00a 2nd meal (6.5oz + 2 T mango)
106 - 5:39p played catch to drive bg up before dinner as I had to leave, Tim gave shot
161 - 6:15p food, 6:27p shot 8 3/4
301 - 9:30p - had been out twice, took her for 15 min walk
251 - 11:00p - 2nd meal
6/16 (rotated injection site)
285 - 6:39a food/shot 8 3/4
277 - 9:40a had been out twice (better insulin absorption - returned to starting 3 hours later) waited to feed to decrease bg a bit
216 - 10:45a 2nd meal
230 - 6:35p food/shot 8 3/4
244 - 9:30p had been out twice, waited hour to decrease bg
209 - 10:30p 2nd meal
6/17
223 - 6:28a food/shot one time bump to 9u
169 - 9:30a had been out twice, 2nd meal
95 - 1:00p 2 small cut frozen green beans
106 - 6:20p played catch to increase bg
133 - 6:40p food, 6:50p - insulin 8 3/4
131 - 9:50p had been out twice, 2nd meal + 1/2 drop honey
140 - 11:20p
6/18
104 - 6:42a played a bit to increase bg, food
135 - 7:00a insulin 8 3/4 - a hair
199 - 10:10a out twice, 2nd meal
165 - 6:29p food/shot 8 3/4
153 - 9:32p out twice, 2nd meal + barely there drop of honey
6/19
193 - 6:32a food/shot 8 3/4
267 - 9:27a out twice, ? absorption issue ?, out to play ball waited to feed
226 - 10:30a 2nd meal, no honey
136 - 6:23p - fed, 6:34p - shot 8 3/4 made sure not to get into thick tissue
79 - 9:30p good size drop honey + 2nd meal
97 - 11:00p
6/20
185 - 6:42a food/shot 8 3/4
83 - 9:30a out twice, 1 drop honey + 2nd meal
82 - 10:30a
70 -11:55a 1/4 t mango
68 - 6:15p out to play catch to drive bg up a bit at end of insulin, 6:23p food
87 - 6:45p - still too low to inject, gave 1/2 drop honey so we don't get too far off schedule
132 - 7:07p, 7:17p - shot 8 1/2 u
I'll keep an eye on her since her food/insulin is off and give a snack if needed but will feed 2nd meal at 3hrs post shot. Usually we wind up back on track in the morning or at least backed up 1/2 hour. We'll see.

I am working my pro/con list to switching insulins. I know at a glance these numbers don't look so bad at all (well, too low at the end)! It's more the big picture of instability I see and how fragile she is with the slightest change in activity due to the action of N that is hard to convey here. The honey addition has really turned the tables for us in the afternoon.

I know even on Lantus I won't be able to feed her in just 2 meals. It will have to be broken up into 4, as she has a history of reflux with quantity of food.

I will be pondering this all weekend...

Thoughts?
Patty

[forloveofandy]

Re: Update on Patty's Ali

Gosh Patty, most of those numbers look good to me.

I discovered through my experiment with the Royal Canine Diabetic food that fiber seems to be key in keeping BG level. Unfortunately Andy is allergic like Ali and can not tolerate many foods. So I had to take him off of it but he had beautiful level BGs when on it. The best he has ever had.

So I started to search for something he could eat that would duplicate the formula of RC and the closest thing I found that Andy could eat was Wellness Protein Focused Grain Free Low Fat It is reasonably high in fiber and holds his BG pretty steady. They also make a grain free canned that is exceptional. All my dogs really love it.

I still put home cooked meat and veggies on top of Andy's just because I feel I need to. I tried fiber supplements and increasing veggies but nothing seemed to have that steady holding power like the higher fiber kibble.

I have also recently learned that even a small amount of exercise has a strong effect on Andy's BG. It drops it. A walk around the block drops his glucose 75 to 100 points.

I finally learned also that Andy would never be good on just one insulin. I started giving him 1U of R in the same syringe as the N. Combine that with the higher fiber food and we finally have success. The R combined with the N acts completely differently from using the N alone in Andy. No more duration issues and no more ups and downs.

Happy Pondering!

[eyelostit]

Re: Update on Patty's Ali

Your numbers look great Patti, you are seeing the lows and catching them, looks like just a small tweak is needed before those times and you are doing well catching it, all I can think of would be a more quick complex carb, but hey looks like you've got this down to a science.

Good Job !

Dolly

[Patty]

Re: Update on Patty's Ali

Thanks Anne and Dolly.

Anne, I remember relating Ali to Andy when I first joined the other board last year. Allergies and deep curves, reverse sneezing with runny nose with the energy level of Dawn's Brandy or Tricia's Lily. Ali was on the Reduced fat CORE then. I did get good numbers with treats during the day to keep her level but her ears got flaming red on it. Apparently, she was allergic to something in the CORE.

This new food really has been wonderful for her. She's never in her life had so much hair on her belly. Usually it's broken out in fine bumps, bright red, or pigmented a dark color without much hair on her inner hips/belly area. But we've been fine tuning to match the insulin for 6 months. I'm thinking it may be time to try to match the insulin to the food.

Last night she went from 132 on 8 1/2 u to:
183 - 9:28p
155 - 10:12 2nd meal + barely a drop of honey like on 6/18

This morning
313 - 6:40a

Likely it was the honey on 8 1/2u vs. 8 3/4u I'm guessing. It's amazing how little effects her. It was barely larger than a pin head. I really doubt she bounced.

I gave her 8 1/2+ this morning where the bottom of the plunger is on the 9. It's probably about 8 5/8u. I think 8 1/2 is too little but wanted to be conservative last night.

Patty

[Margaret Boyle]

Re: Update on Patty's Ali

Thanks Anne and Dolly.

Anne, I remember relating Ali to Andy when I first joined the other board last year. Allergies and deep curves, reverse sneezing with runny nose with the energy level of Dawn's Brandy or Tricia's Lily. Ali was on the Reduced fat CORE then. I did get good numbers with treats during the day to keep her level but her ears got flaming red on it. Apparently, she was allergic to something in the CORE.

This new food really has been wonderful for her. She's never in her life had so much hair on her belly. Usually it's broken out in fine bumps, bright red, or pigmented a dark color without much hair on her inner hips/belly area. But we've been fine tuning to match the insulin for 6 months. I'm thinking it may be time to try to match the insulin to the food.

Last night she went from 132 on 8 1/2 u to:
183 - 9:28p
155 - 10:12 2nd meal + barely a drop of honey like on 6/18

This morning
313 - 6:40a

Likely it was the honey on 8 1/2u vs. 8 3/4u I'm guessing. It's amazing how little effects her. It was barely larger than a pin head. I really doubt she bounced.

I gave her 8 1/2+ this morning where the bottom of the plunger is on the 9. It's probably about 8 5/8u. I think 8 1/2 is too little but wanted to be conservative last night.

Patty

Hi Patty,
Well done Ali,s numbers look great I have to watch Lucy,s lows I am using
Ritz Crackers and milky bones I just wish her nadir would come up a bit the rest of her numbers are good just the low Nadir.
She has changed over to her new diet completely but I will need to give it a week to see if the nadir will come up a bit once she is settled on it.

Ali has got really good numbers (I hope you are proud of yourself) you should give yourself a pat on the back

Hugs to you both

[Patty]

Re: Update on Patty's Ali

I was thinking maybe I should post some numbers from before trying to work with the honey and mango:
This was in May coming off of the rice because it wasn't working on 8 1/2 u
5/28
339/345 - 6:35a 8 ½
294 - 9:30a
213 - 12:00p
210 - 2:00p
213 - 6:28p
202 - 9:02p
162 - 10:30p
5/29
191 - 6:33a
155 - 9:35a
104 - 10:45a
128 - 11:45a
214 - 6:27p
235 - 9:30p
5/30
198 - 6:41a
203 - 9:30a
140 - 11:55a
349 - 6:23p
344 - 9:25p
304 - 10:30p
5/31
303 - 6:39a
90 - 9:30a let her look out the window upstairs instead of resting, added 1 drop honey + 1 T mango
74 - 11:15a 1 t mango
87 - 11:45a
93 - 2:00p
318 - 6:32p
333 - 9:00p
283 - 10:30p
6/1
348 - 7:01a I overslept a 1/2 hour here but repeated everything as on 5/31, letting her look out the window with vastly different results
311 - 10:00a
226 - 11:15a
171 - 1:00p
141 - 4:35p
163 - 6:30p
We just have a lot of trouble with predictability...

[forloveofandy]

Re: Update on Patty's Ali

Oh my gosh Patty even allergic to core. Oh my!

I guess I am lucky then. I have pretty much determined it must be certain grains that Andy is allergic to.

Lucky you found the Primal. I have to be more strict with Andy since I am gone during the day. I have no way to snack him at lows.

I buy Purina Lite Snackers through my vet that are like milkbones but higher in fiber. http://www.purinaveterinarydiets.com....aspx?prod=231

13% fiber compared to 3% in milkbones. Not sure if Ali could eat them but might help with the lows if she could.

[Patty]

Re: Update on Patty's Ali

Thanks Anne.

Thought I'd update from 313 this morning, she was at 181 3hours later. I didn't give her any honey today since she was so high after last night starting at 155 at her 2nd meal. Tonight she was 66 preshot so I guess she needed it.

I let her rise a bit and dropped back again to 8 1/2 after this morning's drop at 3hours and will leave her here.

I was reading through my book again today...Have you guys seen the chart (9.11) in the Using Insulin book on pg 107 regarding how much N can vary from day to day? Sometimes I think we are that to the "n'th" degree, LOL!

I found some interesting articles on variation between Levemir, Lantus and NPH as well as within human subject variability.

http://www.nature.com/ijo/journal/v2.../0802747a.html
"The extent of variability in insulin action is affected by a number of factors, but variability in absorption from the subcutaneous depot seems to be a major contributor; in one study, up to 80% of the variability in the action of NPH insulin could be accounted for by variability in absorption."

"Several factors contribute to the variability in insulin action, for example, site of injection, injection technique, orthostatic movement following injection and prevailing blood flow at the time of injection. However, some factors are inherent to the insulin preparation itself. For example, NPH insulin is a preformed precipitate and incomplete resuspension of this precipitate prior to injection can result in error in the injected dose. This source of variation is overcome when insulin is injected as a solution, such as is the case with insulin glargine. However, precipitation and redissolution following injection can add another source of variation, thus the inherent features of the insulin preparation will be important in ensuring consistent, predictable glycaemic control."

http://press.novonordisk-us.com/index.php?s=43&item=173
It repeats a lot of what I already have printed out, but an interesting read.

Patty

[grace.device]

Re: Update on Patty's Ali

Ali seems a lot like Rolo - incredibly sensitive to tiny dose changes and no predictability to the NPH.

Rolo had no luck on the Lantus (as you know) but the Levemir is much better. Alone, it has a moderately strong onset, and since you are feeding the raw diet, they might work well together.

I know I'm not much help - I never had enough luck with the NPH to give advice, but I hope you get her sorted out

Grace

[Patty]

Re: Update on Patty's Ali

Thanks Grace,
I think basically I'm afraid of Levemir's strength. Maybe if I sat down like you did and really got a handle on the microdosing, but it also makes me nervous to let someone else give her shot.

If I decide to switch I will probably try Lantus first, even though it's more variable. At least it would be a flatter profile in theory.

Patty

[k9diabetes]

Re: Update on Patty's Ali

Hi Patty,

Presumably human diabetics can attest to how difficult it can be to keep their blood sugar in a normal range all of the time, even when they calculate calories and bolus insulin and take exercise into account. Some variation just happens, no matter what you do. I worry that you are "chasing numbers" every day, seeking perfection in regulation that just isn't going to happen no matter what you do.

6/15 (example of day with decreased insulin absorption)
180 - 6:27a food (4.75oz)/insulin 8 3/4
302 - 9:40a had been out twice, took her out to play catch to lower bg
239 - 11:00a 2nd meal (6.5oz + 2 T mango)
106 - 5:39p played catch to drive bg up before dinner as I had to leave, Tim gave shot
161 - 6:15p food, 6:27p shot 8 3/4
301 - 9:30p - had been out twice, took her for 15 min walk
251 - 11:00p - 2nd meal

6/16 (rotated injection site)
285 - 6:39a food/shot 8 3/4
277 - 9:40a had been out twice (better insulin absorption - returned to starting 3 hours later) waited to feed to decrease bg a bit
216 - 10:45a 2nd meal
230 - 6:35p food/shot 8 3/4
244 - 9:30p had been out twice, waited hour to decrease bg
209 - 10:30p 2nd meal

6/17
223 - 6:28a food/shot one time bump to 9u
169 - 9:30a had been out twice, 2nd meal
95 - 1:00p 2 small cut frozen green beans
106 - 6:20p played catch to increase bg
133 - 6:40p food, 6:50p - insulin 8 3/4
131 - 9:50p had been out twice, 2nd meal + 1/2 drop honey
140 - 11:20p

6/18
104 - 6:42a played a bit to increase bg, food
135 - 7:00a insulin 8 3/4 - a hair
199 - 10:10a out twice, 2nd meal
165 - 6:29p food/shot 8 3/4
153 - 9:32p out twice, 2nd meal + barely there drop of honey

6/19
193 - 6:32a food/shot 8 3/4
267 - 9:27a out twice, ? absorption issue ?, out to play ball waited to feed
226 - 10:30a 2nd meal, no honey
136 - 6:23p - fed, 6:34p - shot 8 3/4 made sure not to get into thick tissue
79 - 9:30p good size drop honey + 2nd meal
97 - 11:00p

6/20
185 - 6:42a food/shot 8 3/4
83 - 9:30a out twice, 1 drop honey + 2nd meal
82 - 10:30a
70 -11:55a 1/4 t mango
68 - 6:15p out to play catch to drive bg up a bit at end of insulin, 6:23p food
87 - 6:45p - still too low to inject, gave 1/2 drop honey so we don't get too far off schedule
132 - 7:07p, 7:17p - shot 8 1/2 u

There are a lot of variables in here too. Exercise in various amounts and at various times, delays in meals and injections, which can throw off the food/insulin balance later in the day. That in itself is going to introduce some bouncing around.

I know how hard you are trying to get things just right for Ali, but there is a point at which you're fighting the very nature of the diabetes beast, which, put briefly, is S... happens! And that means you will torture yourself and miss a lot of quality time with Ali. After all, we are replacing a very finely tuned body system with a couple of injections and a diet.

I confess I am doubtful that foods "stop working." What seems more likely to me is that things just vary because that's how it goes and if you had stayed with a particular food you would have found them varying back and then varying away again. There's a lot involved in this that is beyond anyone's control.

So with numbers mostly in the 100s - there really is a LOT to admire in Ali's BG readings, I wouldn't go through changing insulins and upsetting a pretty lovely apple cart.

You can get to the point where you feel like your head is going to explode and no one wants to see that!

Natalie

[Patty]

Re: Update on Patty's Ali

Natalie, I really appreciate your input.
Hi Patty,

Presumably human diabetics can attest to how difficult it can be to keep their blood sugar in a normal range all of the time, even when they calculate calories and bolus insulin and take exercise into account. Definitely. My grandma was one into her 80s. Some variation just happens, no matter what you do. I worry that you are "chasing numbers" every day, seeking perfection in regulation that just isn't going to happen no matter what you do. You are right. I am doing the number chase. But there are times when it's hard not to. I went back and looked, since I test before her meals, we've had 11 out of 22 days in the 300s. And just as many below 100. It can be hard to know when it's safe to leave her. Cutting back her insulin runs her in the high 200-300s. It's such a balancing act. It may sound like I'm looking for perfection but really I'm not. I know she'll have off days but I'd like for them not to be more days out of the week than good ones.

There are a lot of variables in here too. Exercise in various amounts and at various times, delays in meals and injections, which can throw off the food/insulin balance later in the day. That in itself is going to introduce some bouncing around. Typically her exercise time is 2:30p every day or 8 hours post injection. I exercised her here at variable times to try to bring her bg down and give us a lower starting point. The days prior to this were a bit worse with a definite absorption issue going on. The injection delays happen when I'm adjusting dose and don't have it right so she runs too low - very sensitive to change. I'm one that would rather delay a couple of times and tweak the food than reduce the insulin and run high again.

I know how hard you are trying to get things just right for Ali, but there is a point at which you're fighting the very nature of the diabetes beast, which, put briefly, is S... happens! And that means you will torture yourself and miss a lot of quality time with Ali. After all, we are replacing a very finely tuned body system with a couple of injections and a diet.

I confess I am doubtful that foods "stop working." What seems more likely to me is that things just vary because that's how it goes and if you had stayed with a particular food you would have found them varying back and then varying away again. There's a lot involved in this that is beyond anyone's control. My theory here is the added foods we tried looked good the first few days because her body resisted the change. Any time she stays flat across the board is not necessarily a "normal" fluctuation in bg. Then her body adjusted to the change and started giving me a true picture of how things were working together. So I worked on adjusting amounts. The first time I tried mango for instance, she did great with 2T for over a week then starting dropping lower and lower over time, and I kept having to increase the amount until a large amount still wasn't helping. I think our bodies are highly adaptable. The rice was the same way but creating a high on the other end. Ali's problem has always been lows in the middle of her curve, which make a lot of sense when you look at a 2% carb diet and the peak of N insulin...and allergies that don't tolerate many grains.

This is Ali's food: http://www.primalpetfoods.com/product/detail/c/7/id/5 Even if someone's not a raw food fan, they certainly couldn't argue with the results to look at her now vs. before. Her skin is so much better.

So with numbers mostly in the 100s - there really is a LOT to admire in Ali's BG readings, I wouldn't go through changing insulins and upsetting a pretty lovely apple cart. Thanks Natalie. And really I posted because as frustrated as I get sometimes, I'm not sure I'm ready to take the leap either and start all over. If she was completely off again as she was not that long ago, I'd be ready. But she's on that borderline once again of 'almost there.'

You can get to the point where you feel like your head is going to explode and no one wants to see that! Definitely not I'm not sure I've put Lantus to rest yet. Theoretically it just makes sense with her food to me. As a friend told me, if I do switch and it works, I'll wonder what all the fuss was about. My vet has said as well that I just won't know until I try. But if I can settle this new trend a bit, we'll stick with it.

Thanks!
Patty

[ravenecw]

Re: Update on Patty's Ali

That food looks very interesting, I'm not a big fan of the W/D but that is what I'm feeding my dog per the vet (even though I know the vet gets sometype of kickback from selling it- and I know alot do feed the W/D). It's so hard to switch foods, insulins, etc. though. I do however like the idea of my dog getting better nutrition and it's something that is of interest to me.

I am happy that things are looking up, I sometimes too strive for that perfection (my dog's numbers are not near as good as some of the last numbers you posted and I know there is room for improvement, I try and try). Perfection is something I'm letting go of though, my dog seems happy and lively most of the time (even when she is high sometimes, which I know is wierd) so if I can keep her in a "good range" (not necessarily 100's all the time but even low 200's hitting the 100's) I feel pretty good and I will keep working on it however.... I want her to enjoy life and me to enjoy it with her. All the tests and poking and etc... sometimes doesn't help either.

Agian though, I am very happy for you and really like to see good news, it really is inspirational all these stories on here and a good feelling to know things can and do go right sometimes. Who knows, maybe I will try that food out at some point, anything I can do better to make my dog happier (like you have done) is a plus, congratulations again!! :