Remy Newly diagnosed Diabetes

[RemysMom]

My husband has gone to pick up the Humulin R so we will have that. Last night we did OK by splitting his dose. I gave 3U of Vetsulin at 6PM and 3.5U at 10PM with his dinner. The 6PM dose got him down to around 307. He was comfortable last night and totally worn out from his trip to the doctor. I have an appointment Monday for the ACTH test and we will see exactly where his cortisol is at. That way we should be able to determine if it is affecting his glucose or not. I should have results by midweek. Then we can decide about changing his insulin. I will also have them draw enough for a CBC and chem panel and I will bring a urine sample. That way I should have up to date blood work and urinalysis to give to Oncology on the April 1 visit. It will save him having to wait while they do it at the vet school. I would like to see his glucose down although 250-350 is pretty common for him. The Endocrinologist said not to get too hung up on the numbers, look at the clinical signs. We have some meloxicam we can give him proactively until we see oncology. I suspect we will do piroxicam or meloxicam rather than chemo drugs. Again, we will know more when we have all the bloodwork results back and an up to date assessment of his condition. I still didn’t sleep much, my mind is spinning with studies and data but at least I wasn’t full of anxiety. When Remy first became diabetic I trained myself to wake up several times a night to scan his sensor for fear of him becoming hypoglycemic. I guess I’ve never quite broken that habit even though the Libre 3 automatically scans every minute or so and has been very dependable about going off when he gets low. Usually the AlphaTrak reading is a little higher so I have wiggle room to work on getting his glucose up if we need to. I’m trying to come to terms with these most recent developments and the cancer diagnosis and get myself calmed down so I can take the best possible care of my sweet little boy. How does that sound??

Jesse’s Mom, it gets so confusing during times when they actually do better on less insulin and oh yes we have had that happen. I’ve not used the more rapid acting Humulin R which we are planning to use on an emergency basis when he is uncomfortably high. I know people use it in combination with one of the more long lasting insulins but all the vets around here seem scared to do that. To me it makes sense to try to prevent those big post prandial spikes but for now I’m taking it a step at a time.

I just want to add, the Vetsulin measure is U40 not U100 as Humulin would be. I’m setting up a totally separate area for the U100 syringes. We get the U40s that come stored in a sharps container but I am taking every precaution to never them up!!

For the moment I can breathe again and hopefully make the right decisions. Thanks again to everyone for your support, suggestions and knowledge!!

[Riliey and Mo]

have you ever reduced his insulin back to 3.5?

if hes good on that then maybe 5 or 5.5 is too much throwing his numbers out of wack

[jesse girl]

For the amount of testing and monitoring your doing the risk of going to low is slim . In general from what I have seen it is quite rare to go hypoglycemic unless hevealy overdosed . Sounds like you have a well thought out plan and glad your taken all in stride .

The split dose worked very well for Jesse

[RemysMom]

You used a fast acting insulin like Humulin R from time to time right? Did you inject IM or SubQ? Everything I am reading says Subcutaneous but the prescription says IM. I am only going to use it in emergency situations, 1Unit of U100. I am trying to do a split dose in the evening. 2.5 - 3 U and then with his dinner the rest of the dose. I have done 4 or 4.5 U in the past if he was having problems going low. I tried again to post a photo of his Libre data and on the preview it always looks so blurry you can’t read the numbers. I may just post it to see if it is readable or not. He seems comfortable at the moment. I always say midnight is the witching hour for him if he’s going to get uncomfortable. Sometimes I wondered if it was the beginning of doggie dementia since it seemed to be at night that would he get fussy. But once his glucose gets down below 400 he seems to settle down. Hopefully now that I have the Humulin R I will be able to help him when he is miserable. I’ve never seen him have clinical signs of hypoglycemia. We always see on the Libre that he’s going low and it has low glucose alarms that go off. (Oh wow when all our devices are screaming at us it’s so stressful!!) I go for some dextrose or honey and get the AlphaTrak to verify. Usually he’s a bit higher than the Libre is showing but still, it’s hard not to panic. Up until now I haven’t had a way to help him when he was uncomfortably high though. Drs are so afraid of overdosing with the fast acting insulin. I just want to keep him as comfortable as I possibly can. Right now the split dose seems to help a bit. Together it still totals his usual evening dose. It just doesn’t seem to last long once it starts to kick in if that makes sense.

[RemysMom]

Trying again, Remy’s Libre Data
Libre data.png

[RemysMom]

No matter what I do the data is blurry and pretty much impossible to read. I uploaded from iCloud and used the full size attachment here. Claire

[Riliey and Mo]

thanks Claire for the sensor data. i only see times where graph shows he,s dropped below 390 a few times but doesnt show how high his blood glucose rises or maybe i cant see it as its blurry.

i can tell you injecting fasting R insulin at 1/2 unit he should drop around 50 points 15 to 30 minutes after injection
also injecting 1 unit should drop him 100 points

your doing great Claire

[jesse girl]

Yes subq . Never im . 4/6 hours until another dose but that's more about trying to regulate on it . Which some have done . One of them the boss lady of this site .

I used it early in jesses diagnosis when we had no consistency and she wasn't doing well so I was concerned leaving her very high for hours on end but once I figured out her out of the box routine it was never used again. Still sitting in the fridge withe her original dose of vetsulin that was removed from the market at that time . Another challenge we had if we didn't have enough .

You adapt to your reality I am a chameleon so to speak . I don't get down . Just push my way through . I don't look at things as bad or good . It's just life so you just deal with the situation .

With the fast acting stick to a protocol and don't deviate . As mo said you may see a specific amount of drop from one unit and it maybe consistent and may not . It can stay up to 6 hours in the system so not doing any additional or split doses before that 6 hour mark with R may not be a good idea with over lap . If you can muster up a half unit or just below that one unit line maybe a good idea to dip your toes into the pond.

[RemysMom]

Thank you so much for the information. I was pretty sure it would be SubQ although I know in the hospital they often will give it IM. The Libre data only reads to 400 so that’s what the blurry data shows, lots of 400s. We have to stick him to know a reading above that. The Libre readers used to go to around 550 I think but not the smartphone apps. I guess as long as he’s comfortable I’ll let him be. None of his doctors has advocated us using it on any regular basis. The endocrinologist seemed to feel that we need to look more at clinical signs and as long as we aren’t seeing any (high or low) and he’s comfortable just go with it. I remember one time his PCV gave him a 1U dose and it dropped him about 200 points in an hour or so. Lasted about 3 hours and then he went high again. I would definitely do a stick and use the ALphaTrak before using it just to know exactly how high he was. But there are definitely times it may save us a trip to the ER in the middle of the night when he’s miserable. None of this has been easy since Remy was diagnosed three years ago. My other dog that was diabetic many years ago got her two shots a day and everything was always fine. With Remy he’s all over the place. BTW, I am wondering if there is something about the Libre software that blurs the data to protect the patient. It’s fine looking at it on a screen grab or when printed out or at his actual Libre account. It’s only when I try to Upload it to this website that it appears blurred.
Again thank you so much for your input! It’s hard to wait but hopefully next week Wed or Thursday we will have lab work back on his Cushings to help us with this!!

[RemysMom]

UPDATE: Finally got the test results back for cortisol. IMG_4660.png
Baseline 138 and post ACTH 178
So he is not ‘high’. Yesterday we went up to 6 units Vetsulin morning and evening and he got down to 109 a little while ago so this dose seems to be working. First time he’s been below 190 in nearly 2 weeks. He seems to be feeling pretty good so I’m going to stick with this and see how it goes. I’m surprised 1/2 U made such a difference but since it seems to be working I’m not going to question why. Bloodwork was OK as was urinalysis. No abnormal cells were seen in the urine sample but since we have a positive BRAF and the mass is visible on ultrasound we have to assume it is positive for transitional cell carcinoma. Our appointment with Oncology is Monday. For the moment I’m calm, Remy is happily sleeping away and we are thankful for the support and advice you have all provided!! I will keep updating as I learn more!
Claire

[labblab]

Claire, what a good report! It’s such a relief to know that we don’t have to worry about restarting the Vetoryl right now. And I’m so glad to think that you guys are finally having a peaceful evening. You sure deserve it. Good luck with the oncologist visit next week, and I’ll definitely keep watching for further updates.

Marianne

[RemysMom]

Remy did very well today. Nice curve from 3pm till 10.At least I feel like I covered the bases and have a fairly accurate assessment of cortisol level. Hopefully he will do well for awhile on 6units twice a day for awhile. He seemed to feel really good this evening. Thanks so much for the support and advice. It can be overwhelming sometimes and the support here makes a tremendous difference!

[jesse girl]

Glad things have improved . Yeah just minor adjustments can make a big difference . Just take it one day at a time

[RemysMom]

Finally able to get on the forum! So far so good. A few days at 6 units twice a day has worked very well. He seems to feel pretty good. I hope we can keep him comfortable for awhile. I will know more after we see Oncology on Monday. Thanks for the support!!

[RemysMom]

After a few few days of a fairly nice glucose curve (we had increased to 6U Vetsulin twice daily) we are back to an extremely slow response with numbers mostly over 280 and long stretches at 400+ . I just don’t ‘get it’. I’m starting another new vial of insulin today and it’s also the day we change his sensor.
The oncology visit yesterday turned out to be with an Internal Med. Intern doing an oncology rotation. I know she was conferring with the attending clinician but it would have been nice to talk to an expert.They aren’t offering anything new so we will treat Remy with meloxicam for a couple of weeks following a 5 day wash out of his galiprant. Then recheck blood work and ultrasound to measure the mass to see if it has progressed at all.Given his stress levels I think we are going to be pretty much limited to things we can give at home and not IV chemotherapy in the hospital setting.