Winston - Odd numbers; need advice

[Aggie]

Re: Winston's Thread

Ten days ago I had a curve which started with a fasting of 210, stayed in the mid 300s until noon, suddenly dropped to the 200s to mid 100 starting 1 PM, stayed in the 100s or 200s until 4 PM, then back to 360 at 5:30 PM.

I was asking how to flatten it in the morning; it had too much swing and was in the 300s for too long (as in, 6 hours).

So I changed just two things a week ago: a walk lasting 10 more minutes in the morning (30 minutes total now), and switching out 50 calories of kibble for 50 calories of boiled chicken (per meal, total meal calories about 300). Minor things. Kept insulin the same.

Today's curve couldn't be much more different.

Fasting: 181 (at 6:10 AM, insulin/breakfast 6:25 AM)
8:20 AM 236
10:00 AM 198
11:45 AM 220
1:15 PM 210
2:10 PM 234
3:30 PM 294
5:30 PM 419 (because we can't have all decent numbers, apparently)

Well, except for the end it was as flat a curve as the previous one was hilly. Where is the low that usually shows up around 1:30 PM? Should I adjust anything else? Does the insulin just up and quit at the end of the day? Currently Winston is on 7.6 units vetsulin, twice a day, 22 pound dog.

[jesse girl]

Re: Winston's Thread

that curve looks really good

the bounce up is not uncommon . with jesse her bounces went as high as 500 or more in her early days but over time it got jesse and less and now most higher numbers are in the 200s

you might be onto something

[Daisydog10]

Re: Winston's Thread

His curve does look good. You're doing great!

[Aggie]

Re: Winston's Thread

Thanks! I feel like we are finally pretty much there (after 3 months). I would like to see a low closer to 150 in that curve (ironically, the hilly curve 10 days ago had a low like that, but it had a lot of 300s before that point), and I would like the spike at the end to go away, but overall it is mostly in the 150 to 250 target range.

Does anyone have an opinion why his morning fasting has been about 180 while his evening fasting is around twice that? I guess I can't say the insulin 'runs out' at the end of 12 hours if he gets a morning fasting of 180. It only runs out in the daytime, not at night.

I sometimes see that people give a slightly different insulin amount in the morning vs. the evening and have been curious as to how they arrived at that solution. (I fear it involves doing a curve all night, which probably, in all honesty, is not going to happen with us).

[Raysaint]

Re: Winston's Thread

In my first 3 months, I have found a similar situation, meaning his fastings are sometimes higher than the start point and sometimes close to where I want them. I don't think it's about the insulin running out, although it does lose most of it's potency as the 12 hour period ends.
Fastings will be different as the body is in a different state overnight vs during the day. You'd expect better fasting at supper because they are active, but not always the case. Once again, expected consistency will surprise you.
But remember the liver can spill sugar reserves if the body needs fuel and the dog hasn't eaten in 10 hours. Activity during the day can cause a body to need fuel later in the day. I've seen dramatic rises in his sugar before supper, completely unexpected.
You might never know the true answer, as it's not black and white. Diabetes is full of surprises and mystery unfortunately.

[Aggie]

Re: Winston's Thread

Thanks Raysaint. Yes, seems a big jump right before dinner happens to others.

So I have a multiple choice question. The changes I made in diet, lowering carbs by switching out some kibble for chicken, seem to have flattened the curve, but now the curve has lost its 100s as well as its mid 300s/400s and is hanging around the low 200 to low 300 range. I've seen a few high 100s on the new diet (but not today).

Today's curve: Morning fasting was kind of high at 276. But on the positive side his evening fasting was 294 which is the lowest I've seen. Highest number was 310. Lowest number was 212. So the 'swing' is around 100 points which is better than 200 point swing it was a few weeks ago.

The question is, what would you do in terms of adjusting?

A. Nothing
B. Lower the carbs (kibble) a little bit more.
C. Lower something else like the boiled chicken.
D. Raise insulin (I'm sort of afraid to do this as I have seen 150 with this same amount of insulin in the past when there was a 200 point swing from 150 to 360. Maybe raise a tiny amount??? I could go from 7.6 to 7.8 with the syringe I use. Previously 8.0 seemed to have caused a rebound with a morning fasting of 600. I still can't believe that 8.0 can cause a big rebound whereas 7.6 doesn't.

[Raysaint]

Re: Winston's Thread

First I think you should discuss and follow your vet's advice. I would hate to think something happens to your dog based on my or anyones advice.
That being said, my opinion says that the 200 range for BG is the high end of normal, according to my vet. But there is room to improve and room to increase dose a bit. My vet said sometimes just a small increase can hit the sweet spot and be the right dose. I just raised my dog from 7.5 to 8.0, just to get him down a bit from the high end of normal range.
You have seen 150 on the current dose, and 150 is still mid range normal, so if it hit 100 as the low point in the curve, that's still normal. If I could hit 150 I'd be happy right now.
I wouldn't lower carbs, carbs are needed by a body for fuel. You can always balance the insulin versus the carb intake. With less fuel for the body, the more likely the liver will release sugar and burn fat to compensate.

[Aggie]

Re: Winston's Thread

My vet was happy when we had a swing from 360 to 160 and back to 360, with half the time in the 300s. He thought that was just fine because there was a 160 in there. I was not entirely satisfied, so pretty much I feel it's up to me to fine tune this as best I can with any advice I can get from others who have been on this journey.

Today I went ahead and upped his dose from 7.6 to 7.8. I agree with you that, since his 100s have disappeared along with most of the 300s, I have some wiggle room, but not much.

[jesse girl]

Re: Winston's Thread

yes your vet is correct the numbers are acceptable especially if you dont want to put much effort into this but it appears you would like to see a better return and you are correct that you will have to do the heavy lifting

if raising the dose sees more instability than you maybe going in the wrong direction

the key is more stable sugar but how to get there is the challenge

[Aggie]

Re: Winston's Thread

Banking on the hope that a small raise from 7.6 to 7.8 is not going to do anything too drastic. I would like to see him in the 100s and 200s, rather than the 200s to low 300s as the last two curves have shown. The latest curve, from two days ago, looks like this, if this could factor into anyone's opinion:

Fasting 274 (this is actually on the high side, usual would be 180s)
310 at 8:25
233 at 10:15
309 at 11:50
254 at 1:15 PM
231 at 2:05
212 at 3:30
297 at 5:30 (fasting)
If I could just drop all those by around 50, that would be about perfect IMO. Hence the slight raise I'm trying.

[Raysaint]

Re: Winston's Thread

I've been doing half unit increases and they bring numbers down a bit. I think you'll find that going to 8.0 units will be OK to change those numbers.
I know you had a 600 fasting on 8 units, but if that was the first night you gave 8 units, remember the body usually reacts to an increase differently the first day than a few days later.
I think back to when 5.5 units brought my dog's sugar down from 30 to 9 (Canadian numbers) a couple nights, but now he's at 8 units and not where I want him.
Also, has your dog gained any weight back? because that will usually necessitate an increase in insulin.

[Aggie]

Re: Winston's Thread

Good point about the weight. I am keeping an eye on that. He seems to have gained only a little bit (which is good because he was a little chunky before). However, if the trend continues, it worries me because then I'd have to reduce his food and then I suppose the insulin would also have to change. Argh.

[Raysaint]

Re: Winston's Thread

You could also look for a slightly lower calorie food, one that still has a similar carb count, but less fat. Insulin shouldn't have to change much.
With dog food, as one aspect is reduced, another has to increase to add up to 100%. Reducing fat content might mean protein or fiber/carbs goes up. For me, I'd rather match his insulin to carbs, than potentially affect his kidneys or pancreatitis or weight with excess fat or protein.
And being diabetic myself, I'm not afraid of good carbs and fiber.

[jesse girl]

Re: Winston's Thread

go tiny and edge those numbers down a bit if you could could get half of that 50 and sit for a couple weeks then maybe one more tweak . we can always hope

[Aggie]

Re: Winston's Thread

Jesse girl, that's what I am hoping. We might end up at 8 units after all, or maybe not. So far I can say that Winston drank a very normal (as in pre diabetic) amount of water yesterday. I'm holding off on the curve for a week.