Cara earned her wings last nite

[Cara's Mom]

Re: Cara - Need a shoulder!

WE ARE UP 1 UNIT!!!!
That makes it 12 UI/twice day! Starting tonite.
Thanks Kathy

[We Hope]

Re: Cara - Need a shoulder!

Kathy

[Cara's Mom]

Re: Cara - Need a shoulder!

Cara had her Urine test today......looks like an other infection could be lurking!!!!!Sent away for sensitivity and culture. Probably won't be back till Friday!!!! Back on antibiotics in the meantime: Amoxil This is supposed to be little milder than Clavamox. Sure hope so..that was 2 wks of diarrhrea
Ofcourse this has to happen when she was picking-up so nicely!
Well. that's live..two steps forward, one step back!!!!
Does not seem to bother her (yet)....happy, active and has gained 1/2 lbs And everything else is normal: eating, drinking, peeing. Bg's little wacky, but has only been on new dosage for 3 days, need a little more time and/or infection looming?

[We Hope]

Re: Cara - Need a shoulder!

Marion,

When there's an infection in the picture, most often the bg's do go up. The previous one may have been in the picture for a while, as sometimes the infections are there, but there's no evidence of them until you take a urine cuture.

I would venture an opinion here that if Cara does have a UTI, it's not as bad as the previous one. If there is, this one has been spotted and treated early. Last time, Cara was initially taking an antibiotic which had no effect on the bacteria causing the infection. That was when she had the urine culture done and it took Clavamox to make it leave. The chances are that if there's something there, the Amoxil may be working on it.

You might get a clue if you see the bg's start going down--that usually means the antibiotic has had some effect on the UTI. But you really aren't going to have a good test of how the insulin's doing until the question about the UTI has been sorted out.

When people with diabetes get an infection, their bg's most often rise too. And that means for many that they will temporarily need an increase in their fast-acting insulin; the need for extra insulin disappears once the infection is gone.

Those with diabetes do tend to have more infections, UTIs among them. They seem to thrive and grow in the bladder because of the additional sugar in the hyperglycemic urine.

http://petdiabetes.wikia.com/wiki/Ur...ract_infection

Am also going to suppose out loud that because Cara HAS has some improvement with the bg's--they are no longer the constant "meter scorchers" they once were--that if she does have an infection, the less "sugary" urine may have helped her cause there.

Cara may not be troubled with UTIs so much once her bg's get under control and her urine has less sugar in it, as there's less for the bacteria to establish itself with.

And now, another thing to look forward to with regulation--putting these problems to rest too!

Kathy

[Cara's Mom]

Re: Cara - Need a shoulder!

Bg's are not that high, they are just "wacky". AM fasting Bg 's are now on the meter, usual around 18-19. PM are Hi -19. But she peaks at 10 AM, goes gently up and peaks again around 4!? They usually peak at 14 - 15.

[Cara's Mom]

Re: Cara - Need a shoulder!

does that mean her fast acting part of the insulin cannot handle it at the moment....so...indications of infection?

[We Hope]

Re: Cara - Need a shoulder!

Marion,

Right now, what you may be seeing is the point where the fast-acting semilente insulin peaks--around 10 AM--and the second peak at about 4 PM is that of the long-acting ultralente.

http://www.ncbi.nlm.nih.gov/pubmed/9...gdbfrom=pubmed

Pharmacokinetics of a porcine insulin zinc suspension in diabetic dogs.
Journal of Small Animal Practice-1997

"Ten dogs with naturally occurring diabetes mellitus were injected with a highly purified porcine insulin zinc suspension at a dose according to their expected requirement. Plasma insulin and glucose concentrations were measured at two-hourly intervals over 24 hours following injection. There were either one or two peaks in plasma insulin concentration: one at about four hours (mean 4.3 +/- 1.3 [SD]) and another at about 11 hours (mean 11 +/- 1.85) after the injection. The second insulin peak was seen in only eight dogs. Persistence of elevated plasma insulin concentrations ranged from 14 to 24 hours (mean 17.4 +/- 3.65). These results compare favourably with those published for other intermediate-acting insulin preparations used to treat canine diabetes mellitus and suggest that this preparation has useful properties for the successful management of many canine diabetics."

Taking this apart a bit, they say that the first peak at about 4 hours after insulin is plus or minus 1.3 hours. That means it could be 1.3 hours sooner or 1.3 hours later. Then you see them talk about the second peak at 11 hours--plus or minus 1.85 hours later. Meaning that it could be close to 2 hours earlier or later than 11 hours.

These numbers are an average of the times noted for the 10 dogs tested, with 8 of the 10 showing evidence of the second, later peak.

All Lente insulins "operate" like this, in the respect that there are two Lente family insulins combined to produce the insulin--30% fast-acting semilente and 70% slow-acting ultralente.

http://petdiabetes.wikia.com/wiki/Lente

But what's shown as a time activity profile is all of this nicely "smoothed" out:

People who continue to use Lente insulin (beef only now--imported from the UK) and those who formerly used it when it was more widely available would have also had the possibility for the two peaks because no matter what one makes or made the insulin from, it still works in the same fashion.

It may be that you will continue to see two peaks from Cara. When her bg's were so high, it would have been difficult to impossible to have seen it.

Lucky did not show two peaks but just the one later in the day, so he was still keeping with his tradition of not going by the book.

Does this help any--sure hope so!

Kathy

[Cara's Mom]

Re: Cara - Need a shoulder!

Hi Kathy, so again she is doing what she's supposed to be doing!!!!! Smart doggie!
I believed it to be an indication of an infection. Never realized there could be 2 peaks ( Twin Peaks ). Just got my head around "nadir" or "peak" and doing my own curves on Vetsulins webside. Boy, still got a lot to learn
The urine test at the Vet was called "inconclusive" (don't like that word !), little to "murky"( scientific word?!?) and that's why it was sent out. There were no ketones, but Bg's were present, ofcourse.

Thanks Kathy, you are the bestes!

[We Hope]

Re: Cara - Need a shoulder!

Marion,

If you look at this (another "grab" via Google cache from caninsulin.com), noting the blue lines for insulin, you'll see the faster semilente peaking at about 10:00 in the example. Then you see the slow ultralente peaking between 14:00 and 16:00--

Keep in mind that the higher the blue line goes, the harder the insulin is working--the red line is the blood glucose.

Now--let's have a look at another fast-acting insulin--this is R, Regular, or Neutral. This is used to cover meals and to bring down high bg's; it has roughly the same time activity profile as semilente.

See how much that looks like the semilente blue line from about 8:00 to 12:00 on the Caninsulin example?

And now, we take a look at ultralente:

Have a look at this one at about 12 to 14 hours after injection; the "bump" is the tallest--this is the peak of ultralente. Now look back at the Caninsulin example at about 14:00 to 16:00--this is where the ultralente starts working hardest.

I used to watch that show, "Twin Peaks". I agree with you re: inconclusive, but there are times when it's really the only way to describe where we are at this point--what we've done up to now hasn't ruled in anything or ruled it out either.

Nice to know that something that looked worrisome really isn't, right?

Kathy

[Cara's Mom]

Re: Cara - Need a shoulder!

RIGHT!

[Cara's Mom]

Re: Cara - Need a shoulder!

Have other question: Re: those "Twin Peaks"
With the first peak being at 10 AM, around the same time of our walk, will it not be more benificial to change walktime? Let's say more towards the "Valley" time? As a boost for the insulin?
Just thinking

[We Hope]

Re: Cara - Need a shoulder!

Marion,

I think this is worth a try!

http://www.bddiabetes.com/us/main.aspx?cat=1&id=389

"Managing your dog’s diabetes also means managing its activity level. Exercise ‘burns up’ blood glucose the same way that insulin does."

You may find that in changing the time of your walk, the exercise could be more helpful at keeping those bg's down after the 10 AM insulin peak is over.

Boy, still got a lot to learn

I think you're doing GREAT at this!

Kathy

[Cara's Mom]

Re: Cara - Need a shoulder!

Just came back from our walk.....so will try this to-morrow !
I do have lot to learn yet, but with things slowing down a little....my brain starts working again and I seem to able to "reason" better
Thanks Kathy

[We Hope]

Re: Cara - Need a shoulder!

You're darn tootin' you're learnin' those ropes!

Kathy

[eyelostit]

Re: Cara - Need a shoulder!

Sounds like you are taking good care of Cara.

Re: UTI's, Niki has never had this problem, but earlier in her diag she was constantly high and I notices by her PP little crystals hanging from her hair, the doc said it was from the sugar in the urine, so I gave her a wash with my summers eve, went over the area with a tucks pad.

So I wash her PP once a week, sometimes I forget, but I think from the urine with the sugar in it and then sometimes they are laying on the floor leaking the urine that is how they get a UTI, thats just my thought on it.

Niki does seem relieved when I do this, especially when I wash the area behind her PP where the urine would drip on, on the fur.

Maybe I'm just nuts, but she hasn't had a UTI yet.