Johanna's Killian

[johanna]

Up until this past New Years eve.... Killian has been on Merrick can food with some cooked chicken breast in it..
After the Pancreatitis attack I had to feed him a bland diet.....
More work but cheaper !!!!
I have not changed that diet... and his bg has been pretty good for Killian...
between 150 and 300... ( thats not bad for him...)
But at night almost every night his numbers are hi.. in the high 400's....
so Im wondering if some changes can still be made....
this is what he is getting.....
11:00 am- food & shot....
1cup of cooked chicken breast ( or turkey breast)
1cup of brown rice
1/2 cup broccoli or cauliflower... or both mixed....

5:00pm- same as above......
11:oopm... same as above...

He is on 31 units of Novelin N....
no additives in his food ..
Just started him on Enhance....digestive aid ..by aunt jeni's
So im thinking .. is this enough food for his weight?
or too much?
should i be using more of one thing and less of another?
The whole food thing really confuses me....

[We Hope]

Johanna,

Just had a look at what you wrote about Killian and I see that you're now giving 3 meals a day, instead of the 2 you were feeding. Is there any way you can try going back to two meals a day, 12 hours apart, and then the insulin? You have food and shot at 11 AM--I'm going to assume that Killian's bg's are pretty well controlled after that meal and shot.

But then, if we look at the 5 PM meal and then the 11 PM meal, you're giving him actually twice the amount of food you were giving him at 11 AM, but you're expecting the same amount of insulin that covered him for only the one meal to cover him for two. I think that "extra" meal is what's throwing off the insulin and making him go high at night.

I think I'd start by trying to get back to two equal meals 12 hours apart followed by his insulin shot and watch his bg's for a bit before I'd do anything like increase insulin.

Some people who notice that their dogs tend to run a bit low at the point where the insulin's peaking (the time where it's working hardest) do need to give their dogs a little snack to make sure they don't drop too low during that time. But from what you've written here, that doesn't look like this is the case with Killian--you'd like his bg's to come down further.

Some people who notice their dogs have a large "post meal" spike in bg's also might try splitting up the meals from two into smaller, possibly three meal portions. But with Killian, from what you've written, it sounds like he does fairly well until we get into that 5 PM meal where there's no insulin until after the 11 PM meal; by that time whatever you've fed him at 5 PM, has "beaten" the next insulin shot by 6 hours. The morning shot of NPH is starting to wane by then and there's a meal, and then another one, but no insulin until 11 PM.

If there's no medical reason for feeding him three times a day, why not try going back to the two meals and see how the dose you're presently giving handles the two meals? I think you'll start seeing more steady, stable bg's with the two meal system--after watching his bg's on two meals for a bit, this should let you know whether or not he needs to have his insulin increased or not.

[Jody]

Kathy - Killian had a very serious pancreatic attack on New Years Eve - hence the reason for the 5 pm meal.

I forget Johanna - have you explored the possibility of changing the type of insulin that he is on. Any ideas Kathy? I do know that Natalie feeds and injects 4 times a day with R, and that would be tough for Johanna to do - but I think she is in between a rock and a hard spot dealing with both of these issues! :confused: Jody

[We Hope]

If the 5 PM meal needs to be there, what about the thought of "covering" that with some "R" insulin so the bg's don't keep creeping up and up from it? Using some "R" for that meal might keep the 400's at bay and then the NPH given after the 11 PM meal could do its job as well as it seems to for the 11 AM to 5 PM "shift".

[johanna]

I went to 4 smaller meals a day after he got home from the hospital from the Pancreatitis attack....
The vet there said its better for his pancreatitis..... But with my job that makes me leave the house on some days that wasn't working... so I went to 3...
Natale and I talked about using R in the morning.... and again at 5 pm and then N at 11:00pm ... but I didnt go that way yet.... What do you think?
I also felt his bg was more even when he ate more often....
before he always was high.....he was up to 40 units of insulin per shot before the pancreatitis attack....
with the new food he has been much lower..... But I still get the rise later in the day....
would it help if I do another 24 hr curve? and post it?
I can start tonight,.... But hes never the same.....
Arent you suppose to feed more frequent smaller meals with Pancreatitis ?

[We Hope]

Johanna,

You're right re: pancreatitis means smaller meals more often. I think if you can get a curve and post it, it would help us to try to see when Killian's bg's start going up against when he gets fed. I wouldn't want to think of anything different with insulin until you get a curve posted.

Getting a curve going and posting it should show us how Killian deals with the NPH and one meal from 11 am-5 PM and then what happens from the 5 PM meal onward.

[johanna]

You got it... The curve begins Now !!!!!!!!
thank you.....
I also think that the R is something that I will be using soon....
I just didn't understand when you said..." give the r at the 5pm meal??
can I do that? wont the morning shot of N ( 12 hr be to much? ) or should I do R in the morning and at 5 pm... thats a 6 hr gap....
11am to 5pm... R and 11pm N ????????/
Ok im jumping a head of myself.... The curve first.....
I hear your the Insulin Queen!!!!!You know more then books have ever written . WOW are we lucky to have you here !!!!
Thank you so much.....:)

[k9diabetes]

I'm copying here what I sent you earlier in an email as one potential way to do three meals a day.
__________

I saw your notes about potentially using Regular. I think this is something you should try. You'll need to start with a conservative insulin dose and be with him because if Killian is very sensitive to the Regular he could go low quickly.

With three meals a day, if he does well with Regular, you could give him breakfast and Regular, lunch and Regular, and Dinner with NPH. Regular will usually last about 6 hours.

In Chris' case his lowest BG is toward the end of the six hours, just before it runs out.

So if Killian had:

breakfast at 8am with Regular insulin,
lunch at 2pm with Regular insulin, and
dinner at 8pm with NPH, that would be about right.
Or some variation of that. I can't tell you exactly what Killian will do with Regular. You'll have to start with a low dose and test often the first time or two you do it and see how it goes.

Regular usually lasts about six hours. Might be able to stretch it but probably not by much. It all depends on how Killian metabolizes it.

Regular isn't instantaneous... usually takes 20 to 60 minutes to get going strongly. With Chris' diet, he gets a rise in BG immediately after eating. But again, only Killian knows what Killian would do with it. Just be careful and only change one variable - the insulin, test often, and see what you get.
_______________

As far as how much to feed, the easiest thing to do is figure out how many calories you were feeding him on the Merrick - it's usually available on the maker's website if you don't have a can or bag of it anymore.

Once you know how many calories you were feeding, estimate the calories from the food you're feeding now and feed the same amount.

With a plan like described above, you would, at least to start, feed the same amount of food at each meal. Divide the total amount for a day (based on calories) into three equal portions.

If and when you switch regimens, much of what you know about Killian's response to insulin goes out the window. You will just need to go slow with low doses, test, and adjust as needed. But it's very important to be there with him the first time you give Regular, even at a low dose. Usually it's not a problem but best to be safe in case he metabolizes it really really quickly.

Natalie

[johanna]

Nat...
What im going to do is....
Im going to do a 48 he curve.... a 24 wont do it because hes always different...
the same food as i have been giving him ... no changes......
then Ill post it ( with your help of coarse !)....
Then we can take it from there....
I am getting ready to get more insulin so Im going to pick up 2 bottles of R...
I still have a whole unused bottle of N.....
I am giving him 31 units now... ( a drop from 40 before Pancreatitis)
so with R where would i safely start?
The only thing that makes me worry a bit is, you said that the bg is lowest at the 6 hr mark... ( shouldn't it be higher because its wearing off?)...
Killian is always lower right before his shot also with the N.....
I just want to regulate this boy !!!! its been to long now , 16 months....
and would you believe it, he still has 50% of his sight !!!!
If I can keep him in a good range MAYBE he wont loose the rest of his sight....

[Kiska'smom]

Hello again, Johanna,

This diet information is really interesting. My vet doesn't want me to change Kiska's diet right now. He felt that it was important to give her what she will eat to maintain her weight. At some point, I know that I will have to experiment with dietary changes. I'll know just where to come when that time arrives! Hope that you are able to get Killian better regulated on the regular insulin/NPH. That's a new concept for me, too. I can already see how beneficial this site will be! I've already learned a couple of new things tonight!

Jeanne and Kiska

[johanna]

What are you feeding her? and how much?

[ladysmom06]

Hi Johanna,

Sorry:(:( I don't have any advise for you but wanted you to know I was thinking of you and Killian and hoping you get everything straightened out. I'll keep checking to see how you make out with all this. Hugs to you and Killian.

[johanna]

To all who might be here ........
Im really a bit confused tonight... as i posted ever since killian got the pancreatitis... I started feeding him more frequent meals ....
It went from 4 meals to 3 meals because of my schedule....
Also he has been going high in the evening....
To night i had yo be some where( volunteer work I do) every Thursday from 4:30 to9 pm.....
There fore im not home for Killians middle meal....
I always have it ready and my husband gives it to him.....
To night so much was going on here with girls to pick up and drive somewhere.. He forgot !!!!!!
So he missed that meal.....I checked his bg
when i was home, about 9:30 and he was 164... NOT the 390 or 400's that he usually is around now....
So this means just as Natale said... he needs insulin at that middle meal.....
I think he would do better with the 12 hr shot and food but with the pancreatitis that isint good to do Right???/
So if anyone here has a dog with pancreatitis .. I would love to know how often your feeding.... and is there a recommended amount of times to feed a dog with Pancreatitis?
Im so pleased right now with the 164...but I know hes hungry....
I cant feed him now because its to close to his night food and shot....
Should I still do the 3 meals.... ?:confused:

[k9diabetes]

Hi Johanna,

I started to write you some more about the meal and insulin questions this afternoon and then got pulled away to something else.

Since there are plenty of ways to do the three meal plan, I think you can stick with it since it's good for his pancreatitis risk.

You can either...
_______
Use Regular insulin alone for the periods between meals that are close together

or
_________
You can add a little bit of Regular when you give the 5pm meal.


Basically, figure Regular insulin will last about 6 hours and can still have fairly strong action at 4 and 5 hours.
Basically, figure NPH will last about 12 hours and can still have fairly strong action at 7 and 8 hours.

So you could do a plan like I described earlier where the meals during the day are about 6 hours apart and you give Regular insulin only to cover those intervals and then give NPH at night to cover the 12 hours until breakfast.

Or you could give NPH as you are now and some Regular insulin with the 5pm meal. In this case, you wouldn't give the same amount of insulin as you do NPH at breakfast and in the evening.

This is because he still has some NPH in his system when you feed him at 5pm.

So a few additional units of Regular insulin would supplement the NPH still there and help cover all the glucose that's being created by feeding him at 5pm.

But Johanna I feel uncomfortable with you doing any of these plans if you don't understand them.

Basically, glucose from the food Killian eats and insulin from his injections get absorbed by the body. That process takes a little while to get going, goes strongly for a while, and then starts to taper off.

So any time you inject insulin, Killian's body getsa little insulin at first, then the strongest effect it's going to have, and then starts to wane. With insulin, how long that takes depends on the kind of insulin. Regular goes through that cycle in about half the time that NPH does.

Food does exactly the same. Killian eats and his stomach digests and glucose starts getting into the blood stream as the food is digested. A little at first and then the strongest supply a meal will give and then a tapering off.

We tend to talk about the insulin peak as being when the insulin is strongest but that's a distortion. The lowest blood sugar is a combination of when the food runs out AND when the insulin has the strongest effect. If a dog's blood sugar is lowest 6 hours after an injection, this is presumably because he has little or no food leftover and still has enough effect from the insulin to result in a net drop in blood sugar. But the big surge from the insulin undoubtedly happened several hours earlier and was absorbed or used up transporting the glucose.

So when you feed at 5pm, Killian's NPH is still there but nearly as much of it is left to work as there was earlier in the day. The stomach unleashes all the glucose from the 5pm meal and there isn't much insulin to handle it. Result is the blood sugar rises.

You can, as a result, give a supplement of Regular insulin with the 5pm meal to boost the supply of insulin Killian will have for the next 3 hours. Some of the Regular probably will still be left at 8pm if you give him another meal and injection then. But some of the glucose from the 5pm meal probably will still be around too.

By adding some supplemental insulin, you overlap the Regular at 5pm with the NPH at 8pm, actually providing a fairly steady supply of insulin to Killian through all those hours.

Otherwise, you can use the plan I outlined and you feed on the same schedule as the insulin lasts. When the insulin you're giving lasts 6 hours, you feed another meal and give another injection 6 hours later. When the insulin you're giving lasts 12 hours, you don't feed and give another injection until 12 hours later.

So hour 0 = Regular insulin and a meal
hour 6 = Regular insulin and a meal
hour 12 = NPH and a meal
hour 24/0 = Regular insulin and a meal...

In all of these cases, the meals should all be the same size until you see any indication that needs to be adjusted.

Take a look at the food and insulin page: www.k9diabetes.com/insulinfood.html (http://www.k9diabetes.com/insulinfood.html).

There are links there to charts on how NPH and I think Regular are absorbed. http://www.lillydiabetes.com/images/time_activity.gif

I don't want us to tell you what to do. It's really important to me that you understand how this works so that you can decide what to do.

Natalie

[johanna]

Hi Nat....
I do understand what your saying... I think i have come a long way,
When you use to tell me I couldn't get it...
but now when i read it it makes total sense....
What I think i would like to try is this.....
11 am shot and food Nph N
5: pm meal and some R
11pm shot and food NphN
Just to start.....I might go to both morning and early evening with the R
But im afraid to just jump in...
Tonight was a eye opener with the missed meal.... seeing his lower numbers
i do see how the food at 5pmwas raising him... so he has to have insulin then also.....
How much should I start with?
Im getting it tomorrow...

[k9diabetes]

I've always thought talking about the lowest blood sugar as the insulin's peak was misleading and helps cause some of that confusion because it makes it sound like there's a ton of insulin at that point.

Looks like you're giving 31 units of NPH now and three equal meals.

Still I'd start conservatively since you've not been giving any R with meals before and apparently haven't had terrible numbers.

Maybe just 2 or 3 units of Regular and be sure and be there to monitor the blood sugar for the next 6 hours. Check it hourly if you can that first time and see what it does and be sure that you know what his BG was when you injected him with the Regular so you have the starting point.

How much of a concern this first try will be also depends on his BG at the time. If it's 350, it's a lot less of a concern than if its 150. A drop of 90 points is no big deal at 350 but...

So go slow and careful. There's no reason to rush as he's been doing okay on the current regimen.

The other thing that helps with a dog who isn't real predictable as far as BG level is to graph the curves you do side by side, curve on day x and curve on day y and curve on day z all on one chart. Because even if they start in different places, you can often see trends in the shape of the curve regardless of where they start.

Natalie

[johanna]

I just tested Killian before food and shot.....
He was 46.... granted im using a human meter so i can easily add 30 or more to that figure.... but thats still low....
Im not going to give him his shot.....
Ill wait for a hr or so and test him again ... he ate a full breakfast so he should start to rise soon......
I just don't get this boy.... !!!!!!:confused:

[Ricksma]

Even though it is on the low side, really normal range starts at 60...Ricky sometimes does this, and I just make sure he eats enough, and make a VERY small adjustment in his shot. I wouldn't worry about it too much...like I said, Rick does it every so often, with no ill effects. He doesn't go hypo or anything, and it is a fleeting thing.... Let us know.

Love and hugs, Teresa and Ricky:)

[johanna]

I held off his shot....
hes up in the 80's now.... im not sure when i should give him the shot.....
Im thinking soon or its going to through everything off... maybe i should give less insulin....
what do you think?

[We Hope]

I'm wondering if Killian might not be producing some of his own insulin again at times since his bad bout with the pancreatitis. You'd said that he was using less insulin after pancreatitis than before.

If this is the case, it might be why he's so hard to get a "handle" on with all of this. :)

This doesn't happen often, but it's not impossible:

http://www.vetinfo4dogs.com/ddiabt.html#Diabetes%20with%20rebound

"Diabetes that starts out in conjunction with pancreatitis can be really hard to deal with at first since there are other pressures on the hormonal system from the pancreatitis. In addition, once in a while a dog with diabetes in conjunction with pancreatitis will suddenly experience a resurgence in insulin producing capability and a sudden "recovery" from diabetes. If you aren't thinking about that possibility it can lead to insulin overdosage. I doubt that will happen after all this time but if the pancreatitis returns and affects insulin dosage in the future, it may be good to keep this in the back of your mind."

Can't possibly tell you if Killian's pancreas might be putting out a spurt from time to time or whether this is, as Dr. Mike indicates, other hormones at work which are part of the regulation process.

http://petdiabetes.wikia.com/wiki/Insulin#Complements_to_insulin

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

More on how these hormones work (or don't work) together at the links.

If you want to know how much the meter you use differs from the blood testing by the vet, take yours to the next vet visit:

http://petdiabetes.wikia.com/wiki/Glucometer#Meters_for_animals

"You can compare the variance between your home meter and the vet's lab testing easily enough. Take your meter with you when vet blood tests are being done. By using a drop of the same blood sample, you will be able to see how much difference (if any) there is between your vet's equipment and your home meter."

Before anyone can give an opinion about giving the shot--how long since he had his breakfast?

[johanna]

I cant believe you found that .....
I read that when Killian was sick with the pancratitis.....
I posted that on a different sight... and was highly questioned that I must have read it wrong!!!!
I went crazy trying to find that again to prove my sanity but failed !
I couldn't find where i looked ... I had gone to to many sights and i was overwhelmed.....
Yes I did read that.... and up till now i thought I was having a allusion along with everyone else......
I dont know...... He is using less insulin since the pancreatitis....
Was up to 40 units and sometimes 42.....
now its 31.....
as of this morning im not sure how much insulin to give him....Im Leary to give a full dose....
But then again I might be sorry i didn't in a few hrs....
I have to give him his shot soon .... hes a hour late already.....
any thoughts on that?

[We Hope]

If you forget or for any other reason, "blow" a shot, you should be able to give insulin and have it work properly within an hour from when you should have given the shot. I agree with you that he should not have a whole one this time.

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

"Intervet advises a basal dose of approximately 30% of normal insulin dose when a diabetic pet isn't eating. This should be discussed with your vet even if you do not need the information at present. Knowing what he or she considers to be your dog or cat's basal insulin dose should be noted in case of need."

http://www.intervet.com.au/binaries/82_103335.pdf

Page 15

Even though he has eaten, I'd believe you would be safe with giving him 1/3 of the usual dose ASAP because this would keep him from going high with no insulin. He may be a little hard to figure for a bit, because the insulin's supposed to "arrive" at about the same time the food starts digesting (about 2 hours from when you eat--this is why humans with diabetes start testing their bg's about 2 hours after they eat to see if they need to do any "correcting"). But he does need a basal dose to keep from skyrocketing.

The insulin you give doesn't go to work from the moment you give a shot--how fast or how slow it does that depends on the type of insulin you're using:

http://petdiabetes.wikia.com/wiki/Category:Insulins

http://petdiabetes.wikia.com/wiki/Insulin#Kinetics_.26_dynamics

"Insulin Kinetics refers to the time when an insulin can be measured in the bloodstream. It's important to understand that even though it's "officially" made its way there, the insulin has not yet done so in sufficient quantity to effectively begin to lower blood glucose.

"Insulin Dynamics is the point where it has an effect on blood glucose levels.

"A good illustration of kinetics and dynamics is having a headache and taking an aspirin for it. You will get relief after the aspirin's level in your system has reached the dynamic stage. While it is in the kinetic one, you are still waiting for headache relief."

http://www.diabetesnet.com/images/frombook/KinvsDyn.jpg

The dotted line shows insulin entering the bloodstream (kinetics).
The bold line (dynamics) illustrates the insulin at the point where blood glucose is lowered by it.

[k9diabetes]

Hi Johanna,

When Chris is in the same situation, I give him some sugar (frosting or syrup) to bring his blood sugar back up right away and then feed and inject a somewhat smaller dose of insulin.

Sugar is good in that it works fast but doesn't last very long so it won't raise the BG for hours and hours on end. And that keeps him on schedule plus relieves the possibility of the blood sugar dropping still lower after it's checked and found to be low.

Natalie

[johanna]

Hi again....
I went with 25 units instead if the 1/3 because as you can see he was raising fast from the breakfast.....


Date Time B. G +41 Killian Albarron---
?
3/21/08 .. 11:20am.. 178 .. 31 units?. food & shot?.3/4 cup chicken ? 1can merrick?.

3/21/07.. 6:30pm.. 164 .. 1cup chicken breast

3/21/08.. 11:15pm .. 114.. 1can merrick ? cup chicken breast veggies?pumpkin

3/22/08.. 2:00am.. 279.. ?????????????????????.

3/22/08.. 11:00am.. 46 .. dog food ?. 22oz?.

3/22/08.. 11:42am .. 84 .. ????????????????..

3/22/08.. 12:30pm.. 218.. Insulin?25 units?. (raising quickly)

3/22/08.. 1:10pm .. 241.. ????????????????.

3/22/08.. 2:00pm.. 258.. ........... ..........................

[johanna]

Im not sure where I'm suppose to post this?????
Its confusing to me yet.....
I just saw the pictures that were put on of all my kids.... Thank you.... I didnt know if I should say thank you at that post or leave it as a biography ??
So Im posting it here.... Thanks.... Looks great !!!!

[eyelostit]

:)Hey jailbarron, are you able to by the rapid insulin without rx

[johanna]

Hi Deloris....
In the state of Pennsylvania you dont need a rx ... you only need one for the needles....
I didn't use any tonight because he was only 79 before his middle meal...This is all new to me so I hope I did the right thing by not using it to night....:eek:

[Ricksma]

Johanna, How is Killian today? I think you were right in not giving the R last night...it is very strong and if Killie's bg was that low, you really didn't need it. Let us know how it is going today.

Love and hugs, Teresa and Ricky

[johanna]

Hello Teresa....
His numbers have been good the past 24 hrs....
I'de say I have another 24 hrs of good numbers and then he sky rockets again for a day....
I dont know why that happens...
I read a post somewhere , someone asked about Roller coasting ?
It was about the same thing....
I heard R was strong... I still dont know how much he will need.....
How's Ricky? My Lucu is fine.... Still in trouble all the time.... Puppy stuff....
We still haven't gotten tired of the saying " LUcy, youve got some esplanin to do!!!! It just fits her.....

[Ricksma]

Johanna, Ricky is doing great...thank you very much for asking. I took him to the vet today to get nails trimmed, and I wanted him to check his anal glands. I have never had this done, but I noticed once last week that he was "scooting", and I thought "better get it checked". Well, it seems that was a good idea...they were a bit impacted. However, Ricky was not impressed. :eek: hahaha...not funny, I know.

Love and hugs, Teresa and Ricky

[johanna]

Hi all..... Were all back.... thank goodness !!!!
Well I had a issue tonight... Actually it started this morning,,,,
When I tested Killian this morning he was low 80....
so I feed him and dropped his insulin intake by 4 units...
Then this evening at the middle meal when I tested him ( before he ate) He was 39 !!!! so I fed him and used extra veggies for the carbs,,,, I also gave him a milk bone ( something he never gets but loves) I thought that with him being so low it couldn't hurt .... I didn't give him any R and when I checked his bg a hour later he was 89 then a hour later 232.... at that point I began to wonder if I should give him a few unit of the R.... I didn't .... So now I have to ask.... what do you do in a situation like that... and can you just skip the R with the middle meal when hes low before it? :eek:

[We Hope]

I believe I would skip the R. When Killian got down to 39 and he got the Milk Bone plus some veggies with carbs, 2 things happened here.

You were absolutely right to give him both the Milk Bone and the extras for his dinner because he needed to come up from that 39.

In addition to the Milk Bone and the extras helping to raise his bg's, Killian's "fail-safe" mechanism went into effect because his bg's had dropped.

http://petdiabetes.wikia.com/wiki/Hypoglycemia#Aftermath

"A single hypoglycemia or near hypoglycemia episode can result in hyperglycemia for up to 3 days following it. In response to the threat of low blood sugar, the body releases counter-regulatory hormones intended to raise bg's; the body's way of trying to save itself."

http://www.vetsulin.com/PDF/20585.pdf

Page 21

"Hyperglycemia can persist up to three days following a single hypoglycemic episode."

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

"The counter-regulatory hormones adrenalin/epinephrine, glucagon and cortisol/cortisone are released to provide extra energy to the body in various circumstances, or if the body believes it's threatened with hypoglycemia."

It seems to me that we don't know if he's going to suddenly go low again right now--and no one wants to start Somogyi either.

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

I think for safety's sake since he apparently started going low today out of the blue, I would not use any R today but would keep to the rest of my schedule--testing him before the last meal tonight to see what he's reading before I decided how much NPH to give him after he has that. If he appears to be low, you adjusted this morning, and I'd adjust again. But I don't think I would increase the NPH if you have a higher than usual reading because you don't want to get a Somogyi rebound going from this going low episode, and we want to make sure he doesn't dip too low overnight, since he was a "surprise" today. :)

[k9diabetes]

Not sure how low your meter reads but for actual BG under 70 with the potential to go still lower, I'd give some syrup right away.

Doesn't have to be a lot (tablespoon or two) but I don't necessarily know whether the BG is still dropping (more effect from insulin than from food).

And it takes a while for any food, even a very carby one like bread or crackers, to be digested and converted into glucose. Vegetables, if green, would offer very little glucose and could take quite a while to be digested.

When my blood sugar is headed very low, I go straight for sugar. If it's moderately low, I usually go for starchy foods like saltine-type crackers or bread, which are converted pretty quickly, and then follow with some protein to sustain things.

I know that some folks don't like to give syrup unless it's a crisis but I have a hard time understanding why. It will bring the blood sugar up a bit very quickly, avoiding the risk of rebound or of still lower blood sugar before the food gets digested.

I'd give a snack if the blood sugar was, say, 90 and potentially going to go lower.

But at 68, I give Chris syrup and then possibly follow with more substantial food, depending on where in his insulin injection cycle he is. If he's about to eat again, I'd feed him his normal meal with reduced insulin and let the syrup boost his BG back to safe starting point right away.

If his meal was a long way off, and therefore he was at serious risk of going lower still, I'd boost him strongly with frosting or syrup and then give him a snack like a milkbone.

That also allows me to fuss less with the insulin dose because I get the blood sugar back up into a safe range and then reduce the insulin based on the fact that the low occurred. So less changing the regimen back and forth. That's why I like syrup... in quick, out quick, less upsetting of diet and regimen.

Killian's insulin needs may very well drop if you start to get his BG in a consistently flatter, lower range. You won't have all that high blood sugar gobbling up the insulin and cutting its duration.

If you're considering continuing to use Regular, I think it's even more important to incorporate a plan to treat hypos with syrup because of the stronger faster action of the Regular insulin. Any time you've got R on board, consider using instant glucose for lows. Chris' lowest BG during the six hours between injections is at about 4.5 hours after.

Natalie

[johanna]

We Hope...
Thank you for your help ... Now if I can bother you jut one more time....
I dont know how to use this forum....
I thought because it was a new topic that I should post a new topic.... I have been only on one other sight before this so I don't understand how this work yet....
If I post a question in the Johannas Killian how will you know I have a problem?... I know this worked on the cushings sight but its all new to me....
I keep getting email that someone as replied to a post... But Im reading them on my email because I cant find them when I go to the sight.....
If there is someway you can explane to me how this works that would be great......
Thank you for the R advice....

[k9diabetes]

Hi Johanna,

Just post the latest news to Killian's existing thread.

Everyone who logs on sees there is a new post there and will go there to read it. As a result, there will be far fewer threads to wade through, which is the goal of keeping one thread about Killian and putting everything there.

From the CDMB we were all kind of used to screaming "Hey, hey, hey!!! New Post." But it also generates hundreds of individual posts that get buried in the back pages as time goes on.

You'll have to trust that members are interested in you and Killian and will go and read about him when they see something new without you having to shout if from the rooftops! :)

We will read it... I promise!

Natalie

[johanna]

Thanks Natale.....
He up to 569!!!!!! and were 15 minutes from food and shot.....
This is a bit scary now...... Do you think I should cut his novelin N even more even though he so hi.. or do extra?

[johanna]

Thats all fine, I can and will do that.... But I have two threads there which one am I to use? also how do you know if there is a new post? also how do you know where someone posted.... OK stop laughing at my stupidity ... Its all new and change takes some getting use to.....I also dont get the envelopes at the side.... or know if someone is on or not.....
Is there a spot I missed with full directions of how to use this sight?
Am I the only one who dont get it yet??? I hope not I dont want to think of myself as a stupid person !!!
When I have something to say to someone I just sit here at the computer looking everything over trying to figure where to go.... Im sooo Lost .

[k9diabetes]

If it was me, I'd drop the NPH based on the low that occurred and I'd give that and a few units of Regular with his meal.

The point of dropping the NPH dose is to work very hard to get into a more consistent regimen. There are too many variables with the snacks and the Regular sometimes and not others.

The point of the few units of Regular would be to "correct" the very high number and give him some relief.

BUT don't give a lot of Regular and don't try to "correct" his BG all the way down to a good number.

Just give a little Regular to get him out of the screaming highs tonight and then discontinue it.

For the immediate future, after tonight, I would stop the Regular and aim for a dose of NPH that keeps his blood glucose far away from low. Like maybe nothing under 200. Stay there until he's more stable, even if that means his BG is in the 200s and 300s all day.

He might need a day or two to settle down after this rebound situation tonight.

Pick a dose of NPH you can stick to at every injection for 3-5 days minimum (one that keeps him above 200). Don't vary his food and don't vary his insulin unless there's a serious crisis.

Be very very consistent with what he's fed.

If he goes low, give syrup only if you can and drop his insulin dose again at the next injection.

Don't correct his blood sugar with Regular if you can avoid it.
Definitely do not try to "correct" any blood sugar below 400.

Then, when he's stable again - consistently on an amount of food and insulin for 3-5 days and never going extremely low or extremely high, you can try working the BG back down overall.

Killian throws in enough variability. I think you are going to have to eliminate variability from your side of it any way you can if you are going to get him more stable. Consistency is a really really important thing at this point, more important than good numbers.

I remain concerned that you're not confident how and why you're using the Regular. And you can't methodically test how he handles it when he's bouncing around as he has been.

Natalie

[johanna]

Ok ... Im geting ready to do the food and shot....
You said to cut the nph a bi and use some R to bring him down.....
Do I do this in one needle? I was giving him 31 units of NPH....
He was low this morning so I gave him 4 units less....
I fully expected him to be on the high side at the middle meal Noe a low in the 30's..... That was a shock !
So for to night what should I give....
25 of nphN... 4 of R ???? this is a guess.... and should the R go in the needle last so its the first to go in or does it matter?
I think I do have a handle on the R.... I just didn't expect these low numbers....
He is usually on the high side....
Well I'm getting ready ... I wont fill the needle till I here from you...

[k9diabetes]

Theoretically, I closed the new one so you can't post to it anyway! :)

I think We Hope's post went there just before I closed it but I will check to make sure.

Basic rule?

Don't start a new thread.

Ever!

That's a little simplistic, but if it's about Killian keep it in this thread so we can read the whole history when you ask a question.

So to a large degree it's true that there are few reasons to start a new thread.

If you want to post about something else, like an article you read about diabetes or problems with test strips that you read about in the news, THAT calls for a new thread.

If it's about Killian, keep it here.

Because you will always be posting to this thread, it will always be near the top of the board.

Panic posts, in my opinion (which, I suppose, carries some weight since I'm the admin ;) ) should be very rare.

We Hope is going to write up a page on handling emergencies like low blood sugar.

I feel that a forum is NOT the place to get information when there's truly a crisis that requires you to act.

Like very low blood sugar. Look up what to do so you can do it without waiting for someone else to answer, call the vet... whatever needs to be done. Make sure you're prepared for these kinds of likely occurrences.

Asking people here to give very specific dosing advice about a dog they've never laid eyes or hands on with incomplete and imperfect information, even if someone is available in the moment, is asking too much of others and puts Killian at risk if you're waiting for someone to answer a question instead of acting.

None of us knows Killian like you do. If you're going to manage his insulin regimen yourself, you're going to have to be the one who understands what you're doing and why.

Right now, per my previous reply, I'd say Killian is not stable enough to be experimenting with a new insulin. The only reason to add a faster acting insulin is to correct some high blood sugar that's a trend you see repeated daily. Right now, you don't know what Killian's BG is going to do from moment to moment.

So I think the best thing you can do is get back on a reliable regimen until you get to a point where you have a trend for which adding Regular would be useful.

I wonder if perhaps Killian has had some festering low level pancreatitis for a long time and perhaps you resolved it with diet and more frequent smaller meals. If so, that reduction in inflammation in the pancreas could explain why he's needing less insulin now.

Natalie

[k9diabetes]

Well I'm getting ready ... I wont fill the needle till I here from you...

They can be mixed but no need to bother with that for one shot. Just give it in two separate injections.

[We Hope]

Johanna,

If you take a look at the action profile for R insulin, I think you'll see the difference between how it works and how NPH does:

http://images.wikia.com/petdiabetes/images/9/98/Rtap.gif

Time activity profile for R/Regular insulin.

http://images.wikia.com/petdiabetes/images/b/ba/NPHtap.gif

Time activity profile for N/NPH insulin.

The people at FDMB also use something similar to this at times--they call them "boosters" for some reason:

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

I think reading the booster page might help you understand what you'd be using the R for in this case right now.

[k9diabetes]

Ooh, those are nice charts!!

[We Hope]

For some reason, I like ones like this because it seems to me that it's a better illustration of when the insulin starts working,is peaking, and is fading. These are from the wiki--there's one for every type of insulin.

http://images.wikia.com/petdiabetes/images/7/7f/Lentetap.gif

Here's Lente insulin.

[johanna]

The charts are easy to read.... BUT.... It shows the R for 14 hrs?????
I thought its gone after 6......
I took it on myself this last shot.... I read all that was posted after the shot...
I hope i didnt do too much damage....
Hears what I did.....
I was giving 31 units of NPH N... Killians running low all day....
Gave only 27 units this morning... cut it by 4 units.....
To night at middle meal hes down to39.....No Insulin and a full meal....
To night right before food and shot hes up to ...569.....
Looks like rebound to me........
So based on what I remember when that happens you should cut his dosage by 1/3....
I didnt go that far... I gave him 20 units of NPH and filled the rest of the needle with 4 units of R....a total of 24 units......
Hes coming down...he went down to 527..and now he is....516....
I will be checking him every 1/2 hr.....
I probably should have given him a little more R but until i know hoe he responds to it I rather take it slower.....
Although these are hi numbers.....But after a meal he always goes up....
so its working hes not going up but down... Just not enough or fast enough.

[Brandy mom]

Johanna

Not sure if you are still online. How is Killie tonight?
I agree with everyone else you need to stop using the regular insulin until you get Killian stable again. I know killain can be very sure of his BG. But after the problem in January. You have been doing a lot of experments on Killian. Just his diet has been amazing. You have done a great job with finding a diet that works for you and Killie. Just look at how much less insulin he needs.

Lets wait to get everyone else advice. But when I started Brandy on regular insulin. The vet told me I needed to cut the amout of NPH insulin. You are trying to use regular insulin for the middle meal. Do I have this right?

Ok if I am right. Let put on our thinking caps. Could the insulin have a overlap? Would it help to cut the amount of NPH in the morning? Because the regular is going to overlap with the morning dose of NPH. Or would it help to cut the night time dose of NPH? Because it going to over lap with the regular insulin. Or am I just way off base and there isn't any overlap?

Dawn and the girls

[k9diabetes]

Link to how to mix two insulins in one syringe: http://petdiabetes.wikia.com/wiki/Combining_insulin

[johanna]

Hi Dawn....
No its not a overlap.... He was on the low side yesterday for that middle meal ... not real low but in the low 100's so I didn't use the R.
I just picked it up the other day and have used it only once....
Yes is insulin intake has dropped since the Pancreatitis.... he was up to almost 40 units before the attack ....
were down to 31 now and possibly less after this... well see....
The diet is working for him and killing me........
I am buying full Turkeys 6 at a time... (cant fit anymore then that and still have a freezer....) and I have a standing freezer... I need a bigger one,
Im defrosting another one now as we speak....
Im cooking a turkey every other day..... He only gets the breast....
the others get the dark meat....
The Chicken cutlets are so much more expensive.....
I so wish I could go to a simpler diet.... Each meal is Brown rice.... Turkey breast(or chicken) 1 full cup.... thats 3 cups a day....
Fresh broccoli and cauliflower in the food processor... about 1/2 cup
some pumpkin.....
and my kitchen is a wreck after each preparation .....
My husband just walks by me and shakes his head....
I always have to worry that I have meat defrosted and ready.....
The only thing that I have done different in the past week is
I bought Milk Thistle (1000 mg) and SAMe .....
I have been giving him that.... I just thought of that while I was preparing his meal.......
I would LOVE to go to something simpler but with his numbers so off the charts in both directions right now... I cant change anything.....
So another Turkey Ill defrost......:(

[Brandy mom]

Johanna

I think that if Killie diet is not working for you. You need to change it. Having a diabetic dog is stressful enough never mind worring about home cooking. If you don't home cook that doesn't make you a bad mom. I can't home cook. Sometimes I think it would help, but if it make me stressed. What good am I to Brandy and my family?

You need to find a diet that isn't stressful to you. What do you want another stroke. Then you can just adjust the insulin to meet the diet. I worry about you taking on too much.:)

Dawn and the girls

[johanna]

Hi Dawn...
well i just read on how to mix insulins.... I messed that up !!!!!!
Hes still coming down ... In a 1/2 hr he came down from 516 to 436....
I should have used two needles... Didnt want to inject hi twice... but I should have.... I wont make that mistake again.... I see theres a proces to mixing that I didnt do.....
As far as the home cooking.... Thats the problem... It is working !!!
Thats what makes it hard fir me to switch.... Right now I cant do anything..
What are you feeding? I really would love it if everyone could post what there feeding.....
Hows Brandy ?

[Brandy mom]

Johanna

Don't feel bad the first time I used regular insuin I screwed up too. It was my daughter (the one that is a oncology nurse) that told me clear first.

Brandy is Brandy she marches to her own drum. Never does anything the way she should. Now I have her eating Fromm White fish and Potato with Sojo Eutopa and cooked ground turkey. That is for now. This diet gives her a big raise. So I need to change it. Her fur has never looked so good. But she is up to 80 pounds and vet said no more. Not sure what I will change too. I saw something with white fish and sweet potatos. I need to look into that. Her diet is some what limited she will not eat any canned food. I have tried them all.
Dawn and the girls

[We Hope]

Johanna,

What the charts measure is how long the insulin can be found in the system. There may not be enough of it to actually do the work it's meant to--lowering blood glucose, but it hasn't left the body 100%.

http://petdiabetes.wikia.com/wiki/Duration#Intro_to_duration

"The insulin time activity profiles you see are basically averages of blood glucose levels in a test group or groups of patients for a given time period. Some tested patients experienced longer than average duration, while for others it was less than average. Many of the duration test results done by manufacturers of human approved insulins are based on two patient groups--those with diabetes and non-diabetics who agreed to assist in the study. This combined and averaged data is used to generate the time activity profile. It means that there are VERY few with diabetes whose personal insulin activity profile is a perfect replica of those displayed."

http://www.bouldermedicalcenter.com/articles/insulin.htm

"The time of onset, peak activity, and duration of action of subcutaneous insulin preparations can only be approximated. The usually quoted data are based upon the administration of small amounts of insulin to a small number of nondiabetic volunteers."

http://www.ncbi.nlm.nih.gov/pubmed/8112192?dopt=abstractplus

This is an abstract which tells you how they did the testing to establish some of these time activity profiles.

As we talked about before, insulin can be found in the bloodstream before it does one thing about lowering blood glucose:

http://petdiabetes.wikia.com/wiki/Insulin#Kinetics_.26_dynamics

"Insulin Kinetics refers to the time when an insulin can be measured in the bloodstream. It's important to understand that even though it's "officially" made its way there, the insulin has not yet done so in sufficient quantity to effectively begin to lower blood glucose.

"Insulin Dynamics is the point where it has an effect on blood glucose levels.

http://www.diabetesnet.com/images/frombook/KinvsDyn.jpg

The dotted line shows insulin entering the bloodstream (kinetics).
The bold line (dynamics) illustrates the insulin at the point where
blood glucose is lowered by it.

"A good illustration of kinetics and dynamics is having a headache and taking an aspirin for it. You will get relief after the aspirin's level in your system has reached the dynamic stage. While it is in the kinetic one, you are still waiting for headache relief."

When you use more than one insulin:

http://petdiabetes.wikia.com/wiki/Booster#Safety_tips

"Dose cautiously, especially with booster insulins. Once a booster corrects a high BG level, the basal insulin may then appear more effective for the rest of the day -- this can lead to unexpected hypoglycemia."

In this case, the basal insulin would be Killian's N/NPH and the "booster" insulin would be the R/Regular, so when you bring R/Regular into the picture, if you don't cut back on the N/NPH here, it could be too much insulin.

Now on rebound--

http://petdiabetes.wikia.com/wiki/Rebound#What.27s_going_on

"A good explanation of Somogyi is that it occurs when too much insulin has been administered, but the amount of overdose is not enough to cause an actual, full-blown hypoglycemia incident. Because the body detects the fall in blood glucose, the counterregulatory hormones are released just as though it was a true hypo emergency. They signal the liver to release its glycogen stores and convert it back to glucose."

http://www.noahcompendium.co.uk/Intervet_UK_Ltd/Caninsulin/-28708.html

"Owners and veterinarians should be aware of Somogyi overswing which is a response to an overdose of insulin insufficient to cause an actual hypoglycaemia. As a partial hypoglycaemia begins to develop a hormonal response is triggered which results in release of glucose from hepatic glycogen stores."

http://www.vetsulin.com/vet/Monitoring_Somogyi.aspx

http://www.vetsulin.com/vet/images/somogyi_large.gif

Insulin administered at time =0.

And you see here how it's like bouncing a ball.

When we had the weak insulin, since the pork had to be ordered by the pharmacy, we had nothing else except the old vial we were replacing because it was less than 100% potent. Since we didn't know how much potency was left, we had to stay with Lucky's regular dose soas not to increase it and possibly send him hypo. (This all happened over a weekend so you couldn't get the pharmacy to order any insulin until Monday.)

By being consistent and staying with the usual dose for safety reasons, we did get him back to normal once more. We also learned the old vial to be tossed was more potent than the brand new one.

You want him to come down but not so fast because if you don't have rebound now, you might get rebound that way. If you're going to mix insulin, the easy way to remember how to start is "Clear (R) before Cloudy (NPH)".

http://www.bddiabetes.com/us/main.aspx?cat=1&id=258

This is a very good video to learn how to combine insulins--it doesn't hurry you through the process.

[johanna]

Dawn... I thought you didn't home cook..... It sounds like home cooked to me... what is it???
What breed is Brandy? .... I didn't realize you had a big one too..
Do you feed her 2x a day... and how much???
I was using the Merrick... 5 cans a day plus cooked chicken breast...
SO much easier.... But expensive......

[Brandy mom]

We Hope (sorry I can't remember your name)

So what you are saying is the regular insulin could have a different effect on Killie. That after a few days of regular insuilin the body adjusted to it. So there could be an overlap? I don't think Johanna change vial of insulin. So the way the body is using insulin change not the insulin? Or am I more confused?

Johanna

Brandy is a doberman. Her diet is some home cooked but most kibble. I just don't have the time for all home cooked. Sojo Eurota is a dryed vegetable. All I do is add water. So all I am cooking is the ground Turkey.

Dawn and the girls

[k9diabetes]

Tonight Regular was just a boost to get those very high numbers down.

The original plan, I believe, was for Killian to get a meal and NPH twice a day - morning and evening - and mid-day meal accompanied by a few units of Regular but no NPH. There would be some overlap of the Regular because NPH from the morning injection would still be in his system. But the NPH would be starting to wane, plus he would be getting a whole meal to go with it.

He has to eat three times a day to control the risk of pancreatitis.

There are other combinations that would work as well.

Definitely need to cut the NPH if it and Regular are given at the same time.

Boosters keep blood sugar from going from, say, 200 to 300 an hour after a meal. When you don't have a booster, the NPH gets eaten up with all that sugar. So the booster cuts off that rise, which lets the NPH do more work later... cuz there's more of it left when the blood glucose stays level.... not sure if that's any clearer.

Natalie

[johanna]

Well hes down to 279
He was at 436 1hr ago.... Is this seam like a fast drop? Ill be up all night testing him... My poor dog is a pin cushion ......
Ill have the syrup ready if I need it.....
Im glad tomorrow I have no major pains.... so I can be here all day to monitor him,,,
Dawn.. a Doby... I did a rescue for a Doby this summer.... Got a great home in San Francisco ....
Are you not happy with what your feeding??/

[k9diabetes]

Chris can drop that fast without a problem. I don't know about Killian.

Chris bounced up to over 400 this morning, possibly due to a supplement.

11:45a - meal and injection - BG 419
2:15p - BG 293
4:00p - BG 142
6:00p - meal and injection - BG 145 - leveled out nicely!

Natalie

[johanna]

Yes Natale....
That was the plain..... I wouldn't give the R with the Nph...
Just what you explained is what I plained on doing.....
But when he was kinda low last night I didn't use the R....
I did to night with the nph because he was so high....
I did mess up though....
I didn't ave that reading material until after the shot.....
I put the NPH in first...20 units
and the R after it.... ( Backwards..) also they want you to have air in between so they dont mix....
I should have used two needles......
Ill be up a;; night now worrying.....and testing him.....
In the morning when he has his next shot and food Im again going to give les NPH... If hes in rebound thats what to do right?
I wont use any R.....

[Brandy mom]

Johanna
Killie not that low. What time did you give Regular insulin? You don't need to stay up all night. Don't panic

Doby are my favorite breed. My first on lived to be 17. I think we should use the email and not tie up the board with chic chat.

Dawn and the girls

[We Hope]

We Hope (sorry I can't remember your name)

So what you are saying is the regular insulin could have a different effect on Killie. That after a few days of regular insuilin the body adjusted to it. So there could be an overlap? I don't think Johanna change vial of insulin. So the way the body is using insulin change not the insulin? Or am I more confused?


No, what we're trying to say is that when you have R and N together, they have a "one-two" punch. R works faster than NPH, so if you get the bg's down with that, what you need to make sure of is that the NPH, when that goes to work, doesn't send him too low.

http://www.lillydiabetes.com/images/time_activity.gif

Here you see the activity graph for the R and the NPH, where you see that the R works more intensely than NPH, but that NPH lasts a lot longer than the R does. R is a different type of insulin than NPH is--it's classed as fast-acting and the people using it are using this as their insulin to cover the food they're eaten at a meal or perhaps if their bg's are too high. When you use a fast-acting insulin to cover the food you eat, they call it a bolus insulin--these are always either fast or rapid-acting (rapid-acting=Humalog, Novolog, Apidra--analog insulins).

NPH and Lente insulins are classed as intermediate-acting. They're part of what's called basal insulins; they start working slower and keep working longer than any of those you might take for meals. Long-acting insulins are also considered basal insulins--Lantus is one, PZI is one, Ultralente was one, Levemir is one.

If insulins were people, R is up and hard at work when NPH is just waking up. :) The R lowers bg's a lot faster than NPH, but when the NPH starts working, it's also going to do its part at lowering the bg's. So what you want to do is to not use so much NPH because the R that has done some of the bg lowering work already.

If you don't cut back on the NPH some when you use the R, you could set up a Somogyi situation, with swinging highs and lows because the body will respond by raising the bg's when it starts going low. You could also set up an actual hypo because someone's been taken lower by the R and then too low if there's too much NPH in combination with that R.

The R insulin will have a different effect than the NPH does because it's made to work short and fast where NPH is made to work slower and longer. This is because of the difference in the two insulins and what they're meant to do.

[Ricksma]

That is a very concise explanation of what R insulin does, and how it works with the N insulin. I have mixed Ricky's insulin pretty much from the beginning, but I only did that because I had experience doing it before with my other diabetic dog. You have to be really careful with R...it is strong and quick. As long as I am here to monitor Ricky, I feel fairly confident doing this, but even so, sometimes he does go on the low side. Not hypo, thank goodness, but on the low side of normal.

Love and hugs, Teresa and Ricky

[Brandy mom]

We Hope

Thanks for the explaining it. I don't know why I got so confused. That is how the vet told me it works. I must of had brain fade earlier.

I was try to use R for the meal raise. I just couldn't find the right amount. My vet said to cut the NPH by the amount of R I added. So if I was going to use 1 unit of R to cut the NPH by 1 unit. And do a lot of testing. I just couldn't find the right mix and Brandy was bouncing all over the place. So I gave up. Well I gave up for now.

Dawn and the girls

[k9diabetes]

Always keep in mind when looking at a graph of an insulin's duration...

"Actual mileage (in your dog) may vary!" :)

[johanna]

Well as you know I did mess up with the insulin last night....
The R goes in first and then you have to leave air in the needle to match the amount of NPH before you use the nph....
So yes i did mes up and I paid the price... I stayed awake almost all night testing him.....
My damage wasn't too bad though....
After every meal Killian always gets a fast rise from the food and it takes a while before the N starts to work....
Last night even though he was so high he did have a steady decrease in his Bg
And this morning he was 212... His normal numbers.....
although today hes still running on the high side again I feel that could be due to the fact that I didnt give him a full dose of insulin today....
His normal dose is 31 units... but because of the 39... and then the 569...
Im thinking rebound for sure....
so I have cut his dose a bit and hoping in a few days he will settle out..
This morning I gave him 26 units of NPH....
But his numbers have been after the 212....
392..... then 462..... and now at almost 5 hrs after his morning shot and food he's.....210......
My only concern right now is...in about 20 minutes I have to leave to go to where I go every Thursday night ( Volunteer ) in my community from 5pm to 8:30 pm...
And Killians mid meal will be fed to him by my husband.....
He cant test him and I dont want to give him any R tonight .. to cover that meal....
I have to keep him on the same schedule ( no changes ) ....
But I dont know how high he will go when Im gone......
I would not go tonight but Being the President of this organization makes my presence there required.....
I will post his BG results when I return.....
Thank you all for all your help and support.....
We Hope ,,, thank you ... I have printed all you sent me ... and am studying it ....

[Ricksma]

Johanna, It will be okay...try not to stress too much. You are doing a good job, just relax. You are being as careful as can be, and we all know that Killie is gonna keep you on your toes. You are leaving him in good hands...

Love and hugs, Teresa and Ricky

[We Hope]

Johanna,

Years ago we had a really great lady on the other board. Her little one was diagnosed about the same time Lucky was. Along the way, she also developed Cushing's and was dealing with all the issues which come from them both.

She worked full-time so her dogs were at home alone for that part of the day. I never remember her having a hypo incident, but I will always remember something she posted often re: what might be happening while she was at work--"It's in God's hands."

As long as your husband knows what to do and how to do it, I think you can go to the meeting without worrying too much about EITHER of them. :)

[k9diabetes]

No need to worry over a few hours of higher blood sugar, even if it's very high.

This is the temptation you will have to try to resist for the next few days - wanting to "correct" his blood sugar.

Also, until you can settle into an established pattern, there's really no way to know whether yesterday's event was rebound or rapid insulin metabolism combined with all the vegies and snacks given for the low.

If your meter is 40 points low, his BG might never have been lower than 70 and there might have been no cause for rebound. The insulin may have been used up quickly, causing the low number, and then there was none left to go with the food you gave for the low.

This is always the challenge for me in dealing with a low blood sugar and why I use syrup. I don't want to overdo it if I can and just send his BG screaming upward after a low.

If I can be with him, I try to give a moderate amount of syrup and retest to make sure his blood sugar is coming back up.

If I can't be with him, then I will lean toward giving him what is probably too much sugar/food.

Chris' BG is lowest just before his insulin starts to run out of action.

So if his BG is 50 an hour before his next meal, it isn't going to take much syrup at all to bring up his blood glucose level. His insulin's about gone at that point.

If his BG is 50 an hour after he eats, that's the scary one!! Cuz I know he's got a bunch of effective insulin still on board and his BG is going to drop even further in the next couple of hours. So then I give him syrup followed by a snack to give all that insulin something to use.

Hope that makes sense!

Natalie

[johanna]

Im Home and all's well......
I worry to much !!!!
Killian ate almost all his dinner and his bg now is 252..
and thats 2 1/2 hrs after his food.... No R....
Natale...
When you say syrup or frosting are you saying Karo syrup? is that the clear or the dark?
And frosting??? is that the can stuff? I bake so I never have that in the house i make my own...
So if I were to stock some what type would it be ? vanilla?
How much frosting would you give Chris?
I realize every dog is different in size and weight and the amount wold be different depending on there pet....
But a example of what you give Chris for size and weight....

[We Hope]

Johanna,

Frosting--you can buy tubes of it at the store--the kind you buy for writing "Happy Birthday" on a cake or for getting fancy and piping some flowers on it. :) Just make sure you don't use chocolate because it's not good for dogs. I think a tube would be a handy thing to have and just grab when you need it.

Either corn syrup is fine and if you have pancake syrup in the house, you can use that in place of corn syrup.

The only time I had to use syrup was when we were first regulating Lucky with the Iletin II Lente pork insulin--he went low but no hypo or signs of one. He was small so he got 2 ccs of Mrs. Butterworth in a syringe barrel, as per his doctor. I wasn't sure he'd take the sweet stuff on his own, so we used the syringe barrel to get it in his mouth.

Well, we know Killian came out just fine--now tell us, how did Hubby fare? :D

[eyelostit]

Once when Niki went low to a 70 after about 3 hrs after food & shot, I couldn't figure this out:confused:, she must of threw up her food outside, so I gave some regular maple syrup, about 1/2 to 1 teaspoon, I let her likc it off my hand, then some food about 1/2 cup. Check again 3 hrs or so, at 112, this was really weird, so I tested her and she was still low, now she had to of threw up the food, so after about 5 hrs I gave her her homecooked food about 1/2 of it and added about 1/4 c of applesauce, i did not want to give any more syrup, then we got to the 10-12 hrs for food time she had a 130, so I fed the usual meal and decreased the insulin by 1 unit.

Next day we were hi in the 250 range, I was happier seeing this than the low, from then on she was ok.

You may try adding some applesauce or some fruit, I know this is not adviseable for DB dogs, but with lows it seems the only answer I can give

Hope this helps, see my topic on Niki's new meal plan

[Kiska'smom]

Hi Johanna,

I'm mostly just checking in to say hi. I have been trying to read all of the posts about mixing insulin, feeding more than twice day, and I'm overwhelmed. So, since all of this is over my head right now, I have nothing to add! I hope that Killian is doing better. Are you still cooking all of those turkeys? I think my husband would be getting turkey for breakfast, lunch and dinner, too! I don't know how you keep up with it all! Best of luck!

Hugs,

Jeanne and Kiska

[forscooter]

Hi Johanna,

Wow, you have been doing a GREAT job it sounds like!!!!:D I manage my own sugar but really, I give KUDOS to you all who do this with your pups!
I'm not sure if this will help or not but I did have a few thoughts (yes, it's rare but sometimes the blonde hair moves out of the way, LOL!)...:rolleyes:

To help figure out a low too, if there should be one, and you may already know this so I apologize...but a big, steep decrease in BG levels usually would be bc of the R insulin where you would see a more gradual lowering with the longer acting and/or food issue. So, if there should be a low, hopefully it will help figure out what is what!

Also, sometimes injection sites can vary in the "sensitivity". The insulin is left in this little "deposit" under the skin and in different areas of the body can sometimes vary the rate at which it is used (at least it can in people!). These sites can vary among different bodies so what is a good site for one, may be a slower or faster site for another.

I hope this helps some! I know it can be tricky finding just the right combo!!!
Lots of hugs! Beth, Scooter and Bailey

[Ricksma]

Johanna...how is it going with Killian? Did the food change help? I'm really interested to know how you are dealing with the extra time...have you taken up knitting? LOL

Love and hugs, Teresa and Ricky

[Kiska'smom]

Hi Johanna,

I was just checking in. Hope that things are going well! Everytime that I use a test strip, I think of you! Thanks again!

Jeanne and Kiska

[johanna]

Hello everyone.....
I have a issue today.....
I posted the other night that Killian" bg was very low.....
Nat you said to give syrup and wait till his bg rises a feed......
I tested him today before his food and shot and he was 39!
SO... I got out the Karo syrup and put two health globs on his gums and tung,
I then fed him....
Its a hour and 1/2 since then ( no shot) ... and hes only up to 101.....
usually food raises him quickly...
I still didn't give him insulin.....
I also have a vet appointment for Lu Lu and will have to leave here in another hr and one half....
so i'm afraid to give him insulin .... should I wait till I'm almost ready to leave and see whats going on ? or should I just give him some insulin now but only 1/2 of his normal shot?????
or just give him 3 or 4 units of R when he starts to go above 250???????
HELP...........:confused:

[We Hope]

Johanna,

In this case, I think you should take Killian with you to the vet and let him/her give you some advice with him. Don't give any insulin and see what he's doing when he gets to the vet's, then talk with the vet about what's been happening and possible changes to his routine.

Earlier in the thread, we talked about the possibility (rare) that pancreatitis might cause the pancreas to start producing insulin again.

http://www.vetinfo4dogs.com/ddiabt.html#Diabetes%20with%20rebound

"In addition, once in a while a dog with diabetes in conjunction with pancreatitis will suddenly experience a resurgence in insulin producing capability and a sudden "recovery" from diabetes. If you aren't thinking about that possibility it can lead to insulin overdosage."

None of us can tell you if this is happening with Killian, so it's time to take him with you today and see what the vet can advise.

[johanna]

Hi again....
The vet appointment I have is not with my vet......
Because Lu Lu was with my son first, they had her checked by a different vet...
I couldn't get a appointment today with my vet, hes out.... so I called the vet they used.....
I also just called my daughter in law and asked her to take Lu Lu to this appointment.. I don't want to leave Killian....
I just checked him again and hes up to....127... very slow rise.... thats almot 2 hr after food and syrup....
I still didn't give insulin......
I also called the hospital where Killian was that treated him for the pancreatitis and the doctor that treated him wont be in till to night at 8 pm and the vet tech suggested that I talk to her since she knows Killians history......
She also said I could just bring Killian in for a emergency visit and see the doctor on call.......
I hate to go that far with girls coming home from school and me NOT allowed to leave them un attended.....and also pay a high emergency room bill plus Lu Lu's bill if I can handle this my self or at least until one of my vets are in.....
I think I'm going to give him a milk bone... see what that does .
I don't know if this is right or not, but I dont feel like I should be giving him insulin right yet...... what do you think?????:confused:

[We Hope]

I would not advise giving him insulin right now. I would make whatever arrangements I needed to to either see or speak to someone who is familiar with Killian's case. In the meantime, check him every two hours and see how the bg's are doing; you then have that information for whatever vet you are able to get hold of.

Using this guide, he's just a bit out of normal range after the syrup and food--

http://www.thepetcenter.com/exa/nv.html

GLUCOSE 67 - 125 mg/dL

At this point, I'd be concerned that giving him insulin might send him too low. The syrup, as we talked about recently, is a simple carb. It's like R insulin in that it goes to work fast and fades quickly--and this is why, when you have a low, you need to feed something a bit after the syrup--the syrup will get the bg's up but it won't hold them up for too long.

If he's eaten and had no insulin, you don't need to give him a Milk Bone--you shouldn't be running any lows now because there's been no insulin since last night. He's shown you that he did make it up from 39 with the help of the syrup and his breakfast.

Right now, it looks like all we can do is wait and see what Killian's bgs are telling you, but you do need to run this by a vet who is familiar with him today, either in person or by phone.

[k9diabetes]

Not sure where you're at with things right now.

I agree on holding off on giving insulin as long as his blood sugar is staying in a normal range up to about the mid-200s.

What you do after that would depend on how many hours have passed, how close he is to his next meal and injection.

Hope you can provide an update.

Looks like Killian needs a reduction in his insulin dose long-term.

[johanna]

Its now 4:40 pm...and still no insulin....
Killian's Bg is now 346..... still not to bad.....
Can I give Killian about 5 unit of R at 5:30 ? that would be the 6 hr mark....
also something small to eat......
I just think waiting till 11 or 11:30 to night to give insulin is toooooo long,

[k9diabetes]

I would give 5 units of R and NO FOOD.

5 units is only about 20% of his usual insulin dose and the point of giving it would be just to cover the blood sugar he has in his system now.

So don't add any more glucose by feeding him anything between meals.

That should help you get back on track tonight.

[k9diabetes]

What has his regimen been for the past couple of weeks. What food and how much insulin?

[johanna]

Thanks Natale...
See i'm getting it.... sort of !!!!:p

[eyelostit]

Looking at your post:

3/22/08.. 2:00am.. 279.. ?????????????????????.
Was there a treat between these 9 hrs
3/22/08.. 11:00am.. 46 .. dog food ?. 22oz?.
I would have gave syrup, food and fast carb
3/22/08.. 11:42am . 84 .. ????????????????..
Just the Food not raising BG here

Is this after food at 11:00 am?
3/22/08.. 12:30pm.. 218.. Insulin?25 units?. (raising quickly) Did you feed again at this time?


3/22/08.. 1:10pm .. 241.. ????????????????.
This looks normal after food and shot 1 1/2 hr. the 258
3/22/08.. 2:00pm.. 258.. ........... ..........................[/QUOTE]

Can you do a post on what you are feeding now, and is he still on food and shot 3X day or only shot 3 X day etc.

I think the R is causing trouble, that chicken breast for a treat isn't necessarily gonna going to raise the BG as a carb would.

Let us know what Kill's meal is now and how many units? 25 still?

I know you are having a hard time, but something is wrong with diet or shot that can be corrected. :)

thanks ;)

[johanna]

Hey Deloris.... hi there !
You were reading a older post......
today....at 11 am he was 39 !!!!!! that is right before food and shot......
So I gave him syrup and food .. No shot.....
Normally food raises him quickly but it was still a slow rise......
a hour and a half later he was only 101 .....
then in two hrs he was 127 still no shot.....
then at 4:18 pm....he was 342... thats 5 hrs after food and still no shot.....
then at 5:30 pm i didn't give him any food but I did give him 5 units of R
then at 6:37 pm....408
....... 9:17 pm... 370
........ 10:00 pm... 397
So in a hour and 15 minutes its time food and shot......
And here's where I'm stumped......
Do I give half of the amount of insulin?
I usually give him 32 units?
I never had these lows before.... Seams since the pancreatitis , he had been having some.....
Killian was the king of running high ... average in the high 200's and better,,,,

[k9diabetes]

This isn't rebound, and frankly I don't believe in cutting the insulin dose in half even if it is rebound.

Reduce the insulin from what you have been giving. Maybe 15%...

I don't have the details of how much you've been giving and what his blood sugar has been doing so you have to decide how much the reduction should be.

And then you need to stay with the reduced insulin amount and watch his numbers.... don't fiddle with it unless there's something dangerous... just watch and see what he does over a period of time. Trends, not chasing individual numbers.

I thought you cut the insulin dose the last time this happened?

We talked then about settling into a lower dose and creating some stability and consistency.

Did you do that?

[johanna]

Hi Nat....
Yes we did talk about cutting the insulin dose.... and I did.
I was giving him 32 units and went down to 25...
What I didn't know was that I was to keep doing that......
So the next day when he stabled out I went back to the original dose.....
Only now are we talking about keeping it at 25 units for a while....
Im doing the 25 units tonight...and will keep it there for a while now that I know.....
Im also wondering if the WD is the difference?

[We Hope]

Until now, we didn't know that you stayed with the W/D.

http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00105.htm

WSAVA 2001|Diabetes Mellitus: Treatment Options

"Diet—Canine

There is a considerable amount of reliable research data showing that diets high in carbohydrates, low in fat and high in fiber are helpful in regulating diabetic dogs. These types of diets also lowers the average insulin dose, lowers the average blood sugar, lowers the amount of urine being produced and lowers glycosolated hemoglobins and fructosamine levels. The carbohydrates in these diets are complex carbohydrates. It is important to avoid diets high in simple sugars, which includes any commercial diet semi-moist food, primarily those packaged in foil packets. Diets high in sugars are absorbed very rapidly before the insulin has time to work. The goal in controlling the diabetes with diet is to balance the absorption of sugar with onset of action of the insulin. A high carbo-hydrate/low fat diet also decreases plasma free fatty acids, increases the number of insulin receptors, increases insulin action at the receptors, and finally, it decreases cholesterol. High fiber diets reduce insulin resistance. The fiber acts to decrease postprandial hyperglycemia, primarily because it delays gastric emptying. A high fiber diet also decreases absorption of glucose and increases insulin action at the receptor."

We switched to the canned W/D before we switched to pork Lente insulin. Did this while we ordered the insulin and had to wait for the pharmacy to get it from their supplier. We were quitting the insulin we were using because we were at resistance level with it and it wasn't working at all.

Within 24 hours of starting on W/D, Lucky's bg's came down--it was the first time we saw them move that way and stay there. The PU/PD was markedly decreased--and it wasn't the insulin because it was doing nothing before. As a precaution, we cut back on the insulin we were switching from. Had we changed both food and insulin at the same time, I believe Lucky would have had a hypo and he never had one ever.

We had a little guy on the other board who was VERY easy to manage. His vet suggested the W/D would be good for him, so his person switched him to it. The first day he was eating it, it reduced his insulin needs enough to send him into a hypo.

You're now feeding a food with more fiber to it and that makes for better all-round glucose control.

http://petdiabetes.wikia.com/wiki/Fibre#In_Dogs

"Canine studies indicate that a higher-fiber diet improved all glycemic indices: significantly lower fructosamine results and reduction in post-prandial hyperglycemia, among them. Unlike their human counterparts, who, despite other significant improvements, were unable to lower their insulin requirements by the addition of soluble fiber, 9 of 11 dogs in a particular study lowered theirs with adding soluble fiber. Higher fiber diets reduce insulin resistance. Choice of a diet which includes higher fiber is also effective in managing the Post-meal blood glucose rise in dogs; managing this successfully means better overall blood glucose control."

http://www.walthamusa.com/articles/wf103fle.pdf

Page 4

http://www.vetsulin.com/PDF/20585.pdf

Page 13

"Fibre-rich diets have been shown to slow the postprandial glucose surge in dogs, which consequently improves glycemic control."

http://petdiabetes.wikia.com/wiki/Post-prandial

Post-prandial

What this means is that the blood glucose rises when the body begins to digest the food--also known as post-meal spiking or a food spike. This is the rise you see after Killian eats. The higher fiber food keeps this under control better than what he was eating before and this is why you don't see the "fire alarm" bg's he used to have after eating.

[k9diabetes]

Given three hypo episodes in a month, you cannot safely give him 32 units of insuliln. His daily dose will have to come down.

If Killian processes his NPH fairly quickly, he may go too low when the insulin action peaks if the food is digested slowly.

So how long has he been on the same diet and what exactly is that food?

Natalie

[johanna]

WOW... that was impressive .... It just might be the wd !
If this is why hes going low... i could kick myself for not using it from the beginning.....
I do add some cooked meat in it.... and some wd dry.....
For the past 2 days hes has been getting 2 meals a day again.....
could that have something to do with this?
The amount of food did change some.... I no longer force him to finish everything... he usually leaves about a half of cup of food.. I wont let him leave more then that...
He getting a bit over weight and I feel that 3rd meal didn't help his waste line.
I do think he wants something around the 6 hr mark... but a full meal he don't want...
He ate about hour anda half ago and his BG is ,,, Oh MY God...
I just checked him and the meter is saying ,... Warning high glucose above 600........
Now what !!!!!!!!!! should I use some R???????? Fast.... need help !!!!

[k9diabetes]

Johanna,

You're chasing numbers. Leave him alone tonight and get back on track tomorrow.

There's a basic problem here with Killian and that's that there are too many changes being made. You have got to settle into a consistent diet and insulin regimen and stick with it... every day for weeks on end.

There's no way to get a handle on everything when you're constantly changing what food he eats, how much food he eats, how many meals he eats, how much insulin he gets, and then putting out fires...

It's putting Killian in danger.

Natalie

[johanna]

He has been on wd for about 2 weeks now.....
He gets a can and one cup of dry ( both wd)
I usually cook some chicken breast and put it on top to get him to start eating...
I gave him the 25 units to night... but as i said he's reading off the meter right now.......he is dangerously high.....

[k9diabetes]

As long as he's not throwing massive ketones, he's not in any danger from a high.

[johanna]

I just had this happen on the meter once before ... when he had the Pancreatitis.... I panicked when it wouldn't even give me a reading.....
Killian get a fast spike from food right after he eats.... always...
Just today it was slow... but not the norm.....
I also have to realize he had no insulin today except the 5 units of R about 8 hrs ago.......
I don't know if he has key tones,,,,, I'm going to try to get a urine sample and check

[We Hope]

Did Killian get any insulin after eating this last meal? If so, when was he fed, when did he get the shot, how many units of insulin and what type of insulin did you give him?

[johanna]

He had his meal 2 hrs ago.....& shot
and he got 25 units of NPH. N
I usually give him 32 but after today , and what Natale said , I went with the 25 units .
I just checked him again and at least hes reading on the meter now... 562...!

[We Hope]

Have you been able to get any urine to check for ketones?

[k9diabetes]

He's not likely to throw ketones after a couple of hours of high blood sugar... Remember, it was all of 100 at lunchtime today.

Johanna, you are working yourself into a frenzy over this! And there's just no need.

He's not likely to be back into pancreatitis after eating WD and his high blood sugar didn't cause his pancreatitis. His blood sugar is high cuz it's been building all afternoon and his meal piled in on top.

This is why you absolutely have to settle into a routine with him.

This is no way for either of you to live.

I know I don't like trying to manage Killian from a distance with partial information! I don't want to be responsible for a dog half way across the country, you know?

And the only way these panicky posts of yours can end is if you force yourself to settle on the same plan every day...

-- same number of meals at the same times every day

-- same amount of insulin even if his blood sugar isn't always as low as you would like

-- same food fed to him every day

-- same quantity of food fed at every meal.

-- no more waiting hours to give insulin and then trying to fix the high that results.

In all honesty, Johanna, I don't want to continue to give the kind of advice you've asked for today. I can't manage Killian's blood sugar. You have to find a way to do it. I can offer you advice and I have, more than once, emphasized that you need to get on track and stay with a consistent regimen and that it will involve living with some high blood sugar. Whether you choose to do that is up to you, but I am not willing to continue to be dragged into the crises that result when you don't.

I'm working toward a personal rule that I don't tell people how much insulin to give... ever.

I don't want the responsibility and I don't know the dog well enough to be making those decisions. When I change Chris' dose of insulin, I have to know why I'm doing it and what and when I need to monitor. And still there's always some risk with choosing to give less insulin or more insulin or a booster of insulin. I take responsibility for those decisions because I know Chris better than anyone else. I can't ask someone else to make that decision...

Natalie

[johanna]

No .... He never did give me urine......
He wont go out .... he was just out earlier and is sleeping.... I see hes still coming down,,, but Im still going to keep testing him and if he doe go out again before we go to bed Im going to hide the cup under my shirt and try to get it,

[johanna]

Good morning,,,
Hi Nat....
I just read your last post and would like to reply to it....

I totally respect your not wanting to manage Killian long distance, or any dog for that matter... Its a emotional responsibility no one wants.... No should they have......I agree with that....

As far as his food? well I haven't changed his food over and over.....
No I haven't been on Wd from the beginning I wish now that I was because it has made a huge difference....

He was on Merrick can almost all through his diabetes.....
The change to home cooking came from the Panceratitis attack....
That's when the hospital told me to feed him boiled chicken and rice ....
Also told me to feed him less food but more frequently .....

Well its been 3 months since his attack, and the home cooking has been getting to me, as I have said in a different post.....
So That when I tried the WD...and it worked.
I have had to try these different methods of food to see what worked and didn't.....
I realize some people get it right the first try, but I wasn't one of those people

I also realize if I didn't post what was happening yesterday, I would never have known about Wd and all the fiber in it and how it can change the amount of insulin given... so for me that was a good thing.

BUT I do need to correct the statement that :
- no more waiting hours to give insulin and then trying to fix the high that results.
Im not sure where that impression came from?
I have NEVER given Killian his shot hours late or skipped......
If his shot is ever late its by 15 minutes one way or another.....
So I just wanted to clear that up....
I schedule my entire life around Killians food and shot....

I also realize this is a type of sight that is different then the one I have been on in the past.....
This one wants you the owner to learn for your self and not depend on others to fix it.....
Again I couldn't agree more..... If we ( I ) don't learn then how can I help Killian on my own, or anyone else for that matter.....

I do feel as if Killian is on a regular routine.....
and sometimes there is a crisis... he is so unpredictable.......
I just didn't realize posting my stress was so upsetting to you...
or that you saw it that way..... so for that , I apologize and promise if in the future I have a panicky post to post.... I wont post it on this sight.

I also want to say thank you Natale... I do believe with all my heart that if not for you and all the help you have given me and trying to explane everything to me ( over and over) ... until I ( sometime' s) got it....
Killian would not be alive today......

Were back on schedule today... His bg is still a bit high but that might take a few days to settle out.....
Keeping to the routine.... and lowered his insulin and will wait to see if that is the correct dosage or not with the WD....:)

[Brandy mom]

Johanna

How is the big guy today? I think a while ago you started to add Digestive Enzymes to Killie diet. Are you still using them? The only reason I ask is because Brandy was on them too. When I switch to diabetic dog food I was still using them. After a few months Brandy started to throw some lows. I couldn't figure it out. The vet thought it might be the digestive enzymes. He wasn't sure either. He suggested that the enzymes were helping Brandy to digest the food to fast. So when the insulin peaked she didn't have enough food in her system. So I stopped using them and the lows stopped. So it wasn't the insulin that needed to be adjusted at all.

I know how hard it is. But I think you are chasing number now. Natalie correct me if I am wrong. Natalie is the one who told me to stop chasing number. Some dogs are never going to be in the perfect range. So just do the best you can do. Keep them is a regular range of number is beter that bouncing them all over the place. As long as the number are not to high. OK Nat did it sink in?

So I try to keep Brandy fasting in the 200-250 range. Would I like it lower. You bet I would. But it not going to happen. Any time I get it lower she drops too low and then I start chasing number again. So as long as Brandy is happy and playing and drinking or peeing to much this is what it has to be. Do I get strange numbers. You bet this morning Brandy fasting was 400 nothing change everything was the same last nigh. So my first thought is give more insulin. Wrong!!! Just wait it out and see what happen. So if tonight and tomorrow fasting are not better I will try to figure out what is wrong. Brandy is much happier and so am I since I stopped chasing numbers.

Dawn and the girls

[We Hope]

Johanna,

When this site began, you were home cooking for Killian. It was recently that you went with W/D and at one point when you look back at your posts, you were thinking about dropping it. We had no idea if you stayed feeding W/D or not when the problems started.

Everybody I've seen who starts chasing numbers winds up in trouble. We had one person at the other board who became so hung up on numbers, we had to tell this person NOT to do any bg testing for a few days.
The person was told to just stay on routine with the food and insulin on the usual schedule.

You also see some people who want to get everything perfect within days. It would be great if that could happen, but the truth is that it's not going to.

The more alteration from a diabetes routine, the tougher it is for the body to respond to them, because not only are you throwing things at it left and right, the system itself is also throwing things left and right at the body in repsonse to what you're doing from the outside. When you get the counterregulatory hormones working as we do when someone goes low, there's no "light switch" to suddenly turn them off with. They slide back to normal values gradually, and until they do that, bg's are going to run higher.

If you go after them aggressively with changes, they're a lot like bees, wasps or hornets in that they will "sting" you, so to speak. If you just go about your normal routine and let them settle down, they will revert to normal levels and the bg's will become lower.

When we got the brand new weak Lilly pork Lente vial, it happened over a weekend and there was no way to place an order, never mind get a vial of insulin, until Monday. What we had was the older vial of it which was being replaced because it had started losing potency. Comparing the readings, we suspected that the older vial was more potent than the brand new one, so we chose to go back to using that.

But because all we were sure of with the old vial was that is was not 100% potent any more, we decided to keep with the usual number of units for safety. Increasing them with a vial of uncertain potency could have meant Lucky going hypo.

He was given his normal amounts of food and insulin on his usual schedule. By the time the order for a new vial of pork was able to be placed, Lucky was back to respectable ranges. He was high enough from the weak insulin to have visible signs of food spikes (panting) when he'd begin digesting his food. They'd get shorter and shorter every time I gave him his insulin from the vial that was being replaced. We had less than potent insulin and no options at the moment to do anything about getting something else, but we did get control of Lucky's bg's by doing what we did. Our secret for managing this was that we were consistent.

Diabetes is a lot like music lessons. You start out not being able to play much at first, but as you keep at it--keep practicing the piece of music--it becomes easier and easier for you to do it without sounding like a mess. :) You master the piece of music by practice, keep playing it again and again until you have it downpat. You get to that point by doing the same thing over and over.

There's no one who knows Killian better than you do--we can try helping you by offering suggestions, but when we come down to it, you know more about how he responds to things than we ever will.

So why don't we start over here and you tell us about Killian's food, how much and what type of insulin you're giving now and the schedule you're on for both food and insulin?

[k9diabetes]

Hi Johanna,

Although I have, perhaps, a bit more clout at this board than at the other one, I can tell you that my philosophy hasn't changed from the CDMB to here. I don't like telling people how much insulin to give.

I have done it, reluctantly, usually because the person's dog was just diagnosed and they don't have any experience with this stuff yet so they have no basis on which to make decisions themselves.

And I have been criticized in the past for giving that kind of advice by people who find it even scarier than I do. They want me to just say "Talk to the vet."

That said, there are really only two options with diabetes. You let the vet guide you or you learn it yourself.

If you aren't willing to let the vet guide your dog's treatment, you can't ask us to teach it to you one hypoglycemic episode at a time after you've been making changes without understanding what the likely effect of those changes will be.

You want to change diets? Great. What will the effect of that diet change be on the insulin/food balance? Will it provide the same number of calories or are you actually changing not only the composition of the food but also the number of calories you're feeding? How will the protein/fat/fiber balance change? How will that affect his insulin use? Does his typical metabolism of insulin "work" for the new combination of food?

You want to go to three meals a day? Great. How will that change the food/insulin balance? Will you have to change the dose of the insulin because less food will be given at a meal? Will there be enough insulin on board for the mid-day meal to work with the food?

As I understand it, you have not only changed his diet recently to a very different food but also in the past two days changed how many meals you give him (from three to two... how did you apportion the food you were feeding in three meals when you cut it to two?) and changed the quantity of food he's eating by not having him finish the amount of food you were giving him. But haven't changed an insulin dose that put him hypoglycemic twice before. Less food, fewer meals, and fewer calories, especially since WD is low in calories, and no change to the insulin dose... that's a recipe for disaster.

Human diabetics take all of these things into account on a daily basis. Fortunately we don't have as complicated a task but that doesn't mean we don't have to think about these things any time we make any change in the diet, whether in the composition of the food, in how many times fed per day, and in how much is fed.

This one wants you the owner to learn for your self and not depend on others to fix it.

I believe, and it was certainly true for me at the CDMB, that most of the people on all of these boards expect you to learn it for yourself if you are going to manage your dog's diet and insulin regimen rather than rely on the vet for guidance. And it's not for everybody. It takes a lot of self-education and a methodical approach to changes.

I do feel as if Killian is on a regular routine.

I can't say that I can agree with you there Johanna. At least not lately.

and sometimes there is a crisis... he is so unpredictable.......
I just didn't realize posting my stress was so upsetting to you...
or that you saw it that way..... so for that , I apologize and promise if in the future I have a panicky post to post.... I wont post it on this site.

Some unpredictability comes with the territory but the changes you've made in the past couple of days are a major contributor to his hypos this week.

If you just move "panicky posts" to another message board, then you don't understand the core of what I'm saying. A board like this one or the CDMB was never meant to be a substitute for either veterinary guidance or learning the detailed ins and outs of blood glucose management. If you choose to determine diet, number of injections and meals per day, and insulin doses, you have to learn how to make those decisions. If you can't or won't learn how to do it, you shouldn't be making them. You should find a vet who can make those decisions for you and follow his/her advice.

I also want to say thank you Natale... I do believe with all my heart that if not for you and all the help you have given me and trying to explane everything to me ( over and over) ... until I ( sometime' s) got it.... Killian would not be alive today......

Were back on schedule today... His bg is still a bit high but that might take a few days to settle out..... Keeping to the routine.... and lowered his insulin and will wait to see if that is the correct dosage or not with the WD....:)

It's not that I'm unwilling to help or even that I don't appreciate all that you and Killian have been through the past couple of months. I know how deeply you love that dog and want what's best for him. Truly, Johanna, managing every detail of a dog's diabetes isn't for everyone. As We Hope mentioned, sometimes for a serious Type A personality, they can manage the dog into insanity trying to get everything perfect.

It's perfectly okay for someone to choose not to manage their dog's diabetes themselves and allow the vet to determine what the food, feeding schedule, and insulin dose should be.

It's also perfectly okay, and sometimes this doesn't get mentioned enough, to have less than perfect blood glucose control. While Chris' blood sugar is mostly in a good range, he has his share of spikes in blood sugar.

One of the things that concerned me last night is you went from worrying over a low to worrying over a high in a matter of a day, wanting to correct both. Low blood sugar kills. A little bit of high blood sugar is not something to worry about. Killian is not especially sensitive to throwing ketones so while high blood sugar is uncomfortable it doesn't need to be instantly "fixed." Instead the routine that generated the situation yesterday is what needs to be fixed so it doesn't continue to create a crisis.

I hope that makes sense.

Natalie

[Kiska'smom]

Wow Johanna,

I'm out for a couple of days, and it sounds as though you really had a scary time with Killian. I'm so sorry! You know, when I was first posting here and reading about your home-cooked meals and experimentation with mixing insulins, I could not even comment! I thought that I would never be able to balance all of those variables the way that you were. I still can't imagine being informed enough to make those kinds of decisions on my own -- at least not right now. You have tried so hard to do the very best things for Killian. That is what I see in your posts. You may have gotten in over your head here, but we can all appreciate the love that is behind it. My hope is that you will continue to feel comfortable here in posting your feelings and concerns. Maybe what you have been through will help others to see how difficult managing a diabetic pet can be, especially when you are trying new things. A panicky post or two doesn't seem out of line to me! I have made a couple of those myself! Ha! But I do think that it brings home the point that diabetes is a serious disease, and that regulating it can often be an exercise in frustration and anxiety. You just can't let those emotions guide your immediate desire to fix the problem. I really think that you have been a loving and compassionate pet owner. Maybe that love led you a little astray. Once you get Killian back on a consistent diet and insulin regimen that works, you'll be able to put this episode into perspective. It's just too bad that consistency doesn't always mean that you'll see consistently good numbers. I find that confusing, as well; but it seems to be the nature of the beast! You'll keep learning, and I'm sure that the masters here will help you tweak the routine that you and your vet find to regulate Killian. Don't lose heart!

Hugs to you and big pats to Killian,

Jeanne and Kiska