Taylor - Road to Regulation

[CarolW]

Re: Taylor - Road to Regulation

Pat - no reprimands here! Observations, yes. I really think you're doing a top-notch job - don't want to shoot yourself in the foot, at this crucial time! (Um, I guess it's not recommended to shoot the dog's insulin into your foot anyway; ha!)

Looks to me as though you have a good handle on what you're doing, largely - I do feel some concern for the cumulative effect of rapid increases in dose.

What's the date on which you have to board Taylor? No guarantees he'll be able to climb the steps by then, though; we can all wrack our brains in case we can think of some kind of solution to that difficulty. But I think it would be okay for Taylor to be running a bit high at the time you have to board him for a few days. Surely that's better than being on the low side with his BGs at his nadir (low) time of day.

How is Taylor feeling now? Better, I hope! As for you, Pat, I admire your bravery and determination. I might easily have had a heck of a hard time doing as well as you're doing now! I'm just extremely fortunate that my vets are so good - and that I haven't had the associated pressures you have, with your husband and your job.

I'll be watching for your further reports. Likely, sending my friends to watch, too!

Sun, 24 Jan 2010 10:08:04 (PST)

[peggy0]

Re: Taylor - Road to Regulation

I believe its too early to tell. I'd want to give one dose several days before drawing conclusions, but that big of a spike after seeing a 100 is alarming to me I'd do as Carol said and stick with 27 for at least 3 or 4 days. I don't know NPH that well as I'm just converting, but given its powerful, it would worry me to see that spike. We're all learning this insulin together. Thank goodness there are experts out there. Good luck

[k9diabetes]

Re: Taylor - Road to Regulation

I think 28 units is too much. I would go back to 27, maybe 27.5 at most.

The amount of insulin you can give is controlled by the lowest blood sugar reading, which in your case is in the mid 100s - Congratulations! .

Because any time you raise the insulin dose, all of the numbers drop, not just the high ones. So what was 156 might drop to 100. That would be okay. But what if it drops to 60?

You have to tackle the spike in blood sugar after eating with other tactics, not raising the insulin dose.

One of the ways this can be done is to give a tiny bit of Regular insulin with the NPH.

If your dog will eat reliably, you can give the insulin first. It is, of course, a risk of then he doesn't eat.

You can also, if you don't mind doing two injections, give half his insulin first, feed, and then give the other half.

I actually think that, given the surgery deadline, I would go no higher than 27.5. I would sit at that dose for a while, at least a week, and see if the response is the same.

If 27.5 brings his BG down a little bit - nothing under 100 - then I would use either 27 or 27.5 while he's being boarded. Probably just 27. It wouldn't hurt to run his blood sugar just a little higher than you'd like when he's not under your supervision. That would be safer than a potential low.

This really looks good. We could try tweaking to get rid of the spike after the surgery is done and everyone is home and back in their routine.

Nice job of getting him there quickly! I think the vet will be pleased with this.

Natalie

[Taylor]

Re: Taylor - Road to Regulation

Thanks everyone. At 5pm he was 212 with the contour meter, gave food and 27.5 units. I checked again at 5:25pm and he was 201 with the contour and 225 with the one touch ultra mini. It looks to me as if the food just got ahead of the insulin this morning. I was having even worse morning food spikes on the vetsulin. Good advice to cut back on the dose while he is boarded. I still have a few weeks left to figure things out. I also liked the 2 morning shots idea. I don't feel like I know enough yet to try regular insulin.
Pat

[Taylor]

Re: Taylor - Road to Regulation

I need more help with the switch to nph. Since Sunday pm I have given 27.5iu twice a day, and today at 6am got a pre-meal reading of 92. I was still thinking this is okay because it is probably really about 80 pts higher. So I went ahead with a 27.5iu am dose. Now at 5pm which should be his nadir I get a 261, which is a lot higher than it has been running, so I dropped the dose to 26 tonight, in case I am getting some sort of rebound. I’m thinking of staying at 27 am/26 pm the rest of the week and doing a curve on the weekend. Does this sound okay? Today was actually one of Taylor’s better days, as far as how he was acting.
Pat

[CarolW]

Re: Taylor - Road to Regulation

Pat - it's really hard to tell, with ONE reading (that 261 at the time that should have been Taylor's nadir), whether it's just one of those flukes with BG levels (that is, a spike for which we have no explanation), or whether, indeed, that nudge up by half a unit twice a day is setting off a rebound situation.

I guess the only way to find out is to continue testing, and perhaps it would be safer at least to drop back to the 27 units twice daily. As I think about it, I'd probably do that, if it were Kumbi (except HIS dose would be a lot smaller, because he's a small dog; haha!)

As long as you remain aware that it's not at all uncommon to have a spiking BG at some time during a day, or perhaps over a period of two days or so. We recently had this with Kumbi, who, on a day I'd just raised his dose by half a unit (morning and night), suddenly showed up with some high readings - look familiar?

Friday, 18 December 2009
Kumbi had been drinking a lot of water the last day or two; I had a curve on him from 14 December. On 18 December, in the morning, I raised his dose from 6.75 to 7.25 units of Novolin-NPH, twice daily, a.m. I feed at 6:30 a.m. and p.m., and shoot at 7:00 a.m. and p.m.

Kumbi was very restless in the evening, so I did a spot checK:
20:16 - 29.7 mmol/L = 535 mg/dL

Later the same evening:
21:32 - 30.2 mmol/L = 544 mg/dL

And later:

23:28 - 26.3 mmol/L = 474 mg/dL
Rellief! He was on his way down.

Saturday, 19 December 2009

02:04 - 27.3 mmol/L = 492 mg/dL

Geez; going up again, but not drastically. Kumbi is typically on the high side at morning fasting - perhaps he has Dawn Syndrome.

Continuing, Saturday the 19th; fasting:
06:26 - 25.1 mmol/L = 452 mg/dl

Starting DOWN!

08:24 - 25.3 mmol/L = 456 mg/dL

WALK, 08:30 - 09:00, low excitement
Kumbi trotted out well, not tired.

And then, after the walk:
09:04 - 21.1 mmol/L = 380 mg/dL

Consderable drop. Kumbi has always dropped considerably on a walk.

VERY interesting - see the resemblance to your experience with Taylor?

Next day, I started on a new vial.

But no sign of lows, and this all straightened out by the next day, and Kumbi stopped drinking so much water, too.

He was still running on the high side the rest of the day, but settled the next day or two, into his normal pattern.

In short, I don't believe that was rebound. Perhaps Taylor's high reading also wasn't the result of rebound, but a bit of a fluke. With Kumbi, there's always a CHANCE he could have snatched something up along the verges as we walk; he is REALLY fast. Or he might have caught some crumbs off the floor or something.

He's been very settled since, and still running slightly high, so after my next curve, of 17 January, I raised him another QUARTER-unit. Not a half. This NPH insulin is really powerful stuff!

Good luck with Taylor, and I WILL be here watching!

Tue, 26 Jan 2010 15:25:55 (PST)

[Taylor]

Re: Taylor - Road to Regulation

Carol, thank you for easing my mind. I guess I am expecting too much too soon. I have probably reached my limit for unsupervised changes and will just sit tight at 27iu for awhile and give the poor guy a break from constant tests.
Pat

[CarolW]

Re: Taylor - Road to Regulation

Hi Pat,

In the middle of Kumbi's Sacrosanct Time here; just enough time to drop you a note before I fix his insulin injection!

My vet asks me to limit testing for Kumbi, who is considerably stressed by any form of Procedure, not just BG-testing, and BG-testiing is, for Kumbi, his least-liked Procedure.

So, my vets arrange dosing, as far as possible, to maintain good glucose control, yet to minimize the amount of testing necessary for safety.

So, I really like your idea of sticking with 27 units for the time being, as that does seem a safe level for Taylor. And minimizing testing for a time - giving Taylor a break - is something I really like, too!

Do keep us posted on how things go! Rooting for you!

Now off to collect Kumbi's insulin - ha! - I'm finally at a half-unit dose instead of the prolonged series of quarter-unit doses! Half-unit ones are just a bit easier to measure (on a syringe with half-unit markings, of course!)

Tue, 26 Jan 2010 18:48:38

[Taylor]

Re: Taylor - Road to Regulation

Taylor Update—Husband’s hip surgery went well and I ended up taking Taylor along and just running back and forth between car, motel and hospital. I think the change in routine and scenery did him some good. I found a second vet who has diabetes himself and he has helped me cut the diabetes monthly costs from over $800 down to $150. In looking back over the past three and a half months there are at least five things that would have made regulation easier and I wish I had known from the get-go:
1. The initial dose of insulin will likely be too low to show much of an effect. It may take several months to achieve control. Do not assume you are doing something wrong when you do not see immediate results, however, do not remain too long on an ineffective dose while your dog continues to deteriorate.
2. Take on the responsibility for management of your dog’s diabetes as soon as possible. Educate yourself quickly and use veterinarians (most likely more than one) as advisors.
3. Get a human meter with inexpensive test strips and learn to test. Cheap strips are important so you don’t worry about the cost.
4. Try regulating on the least expensive Wal-mart ReliOn Novolin N insulin first. If it doesn’t work you can always move on to a more expensive insulin.
5. Determine dog’s ideal weight, calculate calories to maintain this weight, and choose an affordable, high fiber, easily acquired food that your dog likes. Measure exactly and be consistent. The insulin can then be adjusted to work with the diet.
Taylor has stabilized for the past month at 82.4 lbs and is getting 1510 calories per day with 1 can W/D and 4 cups Science Diet Adult Lite Dry. I am using a Bayer Contour Meter which reads about 80 points low so this curve starting 02/27/10 is going to look a lot better than it is:
0600 125 6.9 1 cup dry and ½ can wd 33 units nph
0900 145 8.1
1100 143 7.9
1200 85 4.7 1 cup dry (will move this up to 1130 on Sunday)
1400 134 7.4
1600 133 7.4
1700 107 5.9 1 cup dry and ½ can wd 32 units nph
2200 131 7.3 1 cup dry
0600 126 7.0 1cup dry and ½ can wd 33 units nph

[Noodle]

Re: Taylor - Road to Regulation

Wow - even with the additional 80 points, that is a wonderful curve. No huge spikes or dips. Glad to hear Taylor is progressing so well and that your husband's hip surgery was uneventful.

[eileen]

Re: Taylor - Road to Regulation

Glad to see things going better for both you and Taylor.

Adding my input from my own personal experience...

For the first 5 years I carefully measured Mildred's food, several months ago I bought a scale and have gone to weighing each meal so to be exact. I am finding this to have an advantage.

I also used the Contour meter for a period of time until I soon began seeing irratic readings, I then tested it against the Freestyle and since the Alpha Trak and found it to be quite a bit higher than where Mildred actually was. Because I was depending upon my readings to make insulin adjustments I couldn't have this. It took me a week or two to get Mildred back under control once going to a more accurate (for Mildred) meter.

Just want to point out too that Walmarts ReliOn Novolin N is exactly the same as the more expensive Novolin N....price of the insulin has nothing to do with how well it works. Some dogs do better with Novolin while others Humulin, others it doesn't matter.

You make very good points...education on the disease is essential.
I too have figured the caloric content of Mil's food so to keep her weight steady with her insulin working well with the diet.
If extra fiber is needed but one does not want to adjust the diet you can add Benefiber to each meal.

What a great looking curve!

Eileen/Mildred

[Patty]

Re: Taylor - Road to Regulation

Very nice and great tips!!

[k9diabetes]

Re: Taylor - Road to Regulation

1. The initial dose of insulin will likely be too low to show much of an effect. It may take several months to achieve control. Do not assume you are doing something wrong when you do not see immediate results, however, do not remain too long on an ineffective dose while your dog continues to deteriorate.

2. Take on the responsibility for management of your dog’s diabetes as soon as possible. Educate yourself quickly and use veterinarians (most likely more than one) as advisors.

3. Get a human meter with inexpensive test strips and learn to test. Cheap strips are important so you don’t worry about the cost.

4. Try regulating on the least expensive Wal-mart ReliOn Novolin N insulin first. If it doesn’t work you can always move on to a more expensive insulin.

5. Determine dog’s ideal weight, calculate calories to maintain this weight, and choose an affordable, high fiber, easily acquired food that your dog likes. Measure exactly and be consistent. The insulin can then be adjusted to work with the diet.

These are all great suggestions. I especially agree with number 2 for those willing to dig in and learn.

Vets sometimes present decisions about diabetes like it is rocket science and only a medical professional can do it.

BUT human diabetics can't run to the doctor every day for advice on how much insulin to give. They must learn to manage it themselves - they count carbs, calculate doses, take exercise into account.

So it's perfectly acceptable as far as I'm concerned for people to manage their dogs' diabetes as long as they are willing to do their homework - you wouldn't want some people to manage their dog's diabetes as badly as they manage theirs!!

Learning includes recognizing the differences between human and canine diabetes and adjusting for the fact that the dog can't say "Hey, I think my blood sugar is low - please check it for me!"

So it's a skill but an entirely attainable one.

We switched vets around 2006 and by that time, I was managing Chris' diabetes entirely on my own. I had slowly taken it over bit by bit and was using insulin that did not require a prescription.

The new vet, in 2+ years of treating Chris for his many other problems, never even brought up his diabetes. He knew I just handled it and didn't worry about it. That was a real gift for us - to have that trust. One of the reasons I left the other vet behind - there was more than one - was that she did not ever really trust me to handle it.

And the staff would make big generalizations about what one can or can't do.

Like they just flat out informed me that most diabetic cats cannot have blood sugar tested at home. Now, admittedly, I don't think my cats would ever tolerate it - they are wild things with no manners. But the tech's opinion sure would come as a shock to the dozens of people on the feline diabetes forum who test their cats' blood sugar all the time.
In fact, we have a link to a great video of a cat being tested on our Home BG Test Videos page (www.k9diabetes.com/bgtestvideos.html) just because it's such a great video and so encouraging to people afraid to test!

I know the new vet had our situation explained to him by the internal medicine specialists who referred us to him but I hope that he could grant the same trust to other clients willing to take on that kind of management themselves.

Natalie

[Taylor]

Re: Taylor - Road to Regulation

Help! I usually give the shot in the scruff of the neck but Taylor has been running really high all day so I decided to try a different spot along his flank. It didn't go well and now his fur is all wet and I now know what the insulin smells like. I assume I can't give anymore insulin. How high is he likely to go and can I test again at 10pm and if he is high not give him the cup of dry food he would normally get? How long is it going to take to get back on track?
Pat

[CarolW]

Re: Taylor - Road to Regulation

Hi Pat,

Hey, don't panic, and don't beat yourself up! You'd NEVER be able to call yourself "experienced" till you've done at least ONE fur-shot! haha!

Taylor will be fine!

Just resume a normal schedule!

About shooting along the sides instead of into the scruff, you don't in fact have to pull up skin very much. If you can get hold of even a tiny fold, that's enough. And some people don't even do that, but just slide the needle under the skin, at a very narrow angle, so as not to hit anything vital!

The pictures on these pages might assist you some:

http://www.coherentdog.org/vek/bevelup.php

(scroll down to the third picture on that page).

For detail of what the picture there is a diagram of, you can look at the one on this page:

http://www.coherentdog.org/vek/inject.php

You could also drop in on Carolyn and Gretel's thread, where there's some discussion, and a picture of alternative sites for injecting.

http://www.k9diabetes.com/forum/showthread.php?t=1690

Have fun - ha! I hereby dub thee Semi-Expert!

Sat, 6 Mar 2010 17:10:05 (PST)