The Wee Dude Alfie earned his wings 23rd June, 2015

[k9diabetes]

Re: Alfie's Story so far....

Maybe cut his insulin more drastically... down to one half of a unit... and see how it goes.

I just printed out your entire thread and will write more after I've had a chance to review it.

Natalie

[peggy0]

Re: Alfie's Story so far....

Do you have another bottle of insulin handy? i'm just wondering if there is something wrong with this vial? It would be worth it to me to try this reduced dosage with a new bottle and see what happens. I've read most of your thread and I don't see any reason as to why this would be so erratic.

[k9diabetes]

Re: Alfie's Story so far....

I just went back through your entire thread and the thing that struck me most strongly was how well Alfie did on his curve on June 2nd when he got a snack at 2pm.

That curve showed a much better balance of food to insulin than the one on June 11 with larger meals and no snack.

June 2nd Curve with 2pm Snack
8am- 13.2 mmol = 238 mg
---9am - 40g burns high oats
---9.30am - 2.5units caninsulin
10am - 12.2 mmol = 220 mg
12pm - 10.5 mmol = 189 mg
---2pm - 20g burns high oats (new snack time)
4pm - 8.5 mmol = 153 mg
6pm - 8.2 mmol = 148 mg
---Alfie walked 6.15pm to 7.30pm
8pm - 12.2 mmol = 220 mg
---9pm - 40g burns high oats
---9.30pm - 2.5units caninsulin
10.30pm - 15 mmol = 270 mg
12.30am - 10 mmol = 180 mg

June 11 Curve with Larger Meals and No Snack
8.45am 30.4 = 547
---9am 50g burns high oats food
---9.30am 2units caninsulin
10am 28 = 504
---10.15 - 10.45 Alfie walked on lead
11am 25.8 = 464
12pm 10.8 = 194
1pm 8.3 = 148
2pm 6.9 = 124
3pm 19.1 = 344
4pm 22.4 = 403
5pm 26.7 = 481
6pm 28.2 = 508
7pm 27.6 = 497
---7.30pm - 8.30pm Alfie walked
8.30pm 31.4 = 565
9pm 29.3 = 527
---9pm 50 g burns high oats
---9.30pm 2 units caninsulin
10pm 28.1 = 506
11pm 22.8 = 410
12am 17 = 306
1am 15.7 = 282

What time did each hypo occur in the last few days?

I want to see if they are at expected low blood sugar times.

And what is his food and injection schedule now?

I know you quit the snack for a while but I think were going to add it back in.

The other thing that struck me is that you have had a lot more problems since going to the Burns High Oats. I know you don't like the WD but if it offered Alfie a more stable response to his insulin, it might be better than the roller coaster you have been on recently.

In addition, he's lost another half a kg so that's probably contributing to his need less insulin.

He also may have a lot variation in his response to food and insulin, doing major wobbles, which means you have to keep his blood sugar high enough that he can wobble downward and not go too low. Given his history of pancreatitis, he could have some chronic inflammation in the pancreas that affects his blood sugar levels. Maybe some at least sporadic pancreatic insufficiency, which could be leading to the weight loss despite the additional food.

I would cut his insulin for now by another half or maybe a full unit and then if you can clarify what you have been doing as far as what you have fed and when, we can try to formulate the best possible meal plan for him.

The goal would be to get entirely away from low blood sugar for a week, even if that means living with higher blood sugar than you would like long-term. Once he's had no hypos at all for a week, we can look at his curve and decide what the next step should be.

Natalie

[diggydog]

Re: Alfie's Story so far....

Hi Natalie,

His hypos have been at 5.30pm, 8.30pm, 11pm and 7am roughly.


Alfie still had hypos on the w/d and he was miserable the whole time as he was totally starving all the time on it so I am a bit reluctant to put him back on it if its going to make him so unhappy to be honest. He was a bit sick on saturday afternoon but not again since but I am now wondering if this is more significant than I first though.

[k9diabetes]

Re: Alfie's Story so far....

Daisy had some problems with Noodle when she tried increasing the amount of food he ate. It just didn't balance with the insulin the same way the old amount did.

But the constantly decreasing insulin dose seems like a separate issue to me...

"Honeymooning" where the dog starts producing insulin again is a remote possibility, one I don't think all that likely given how long he has been diabetic. This usually happens only early on. But maybe he didn't read that particular book.

Addison's disease is a lack of cortisol production and that makes a dog extremely sensitive to insulin with hypoglycemia as a result. Diagnosed with a blood test.

Cushing's disease is the opposite of Addison's and in an early stage I could see it improving something like chronic pancreatitis and so possibly restarting some insulin production or, by reducing inflammation, meaning he would need less insulin. His original dose was on the higher side of normal.

And then the GI or pancreatic issues are a possibility. If the food isn't being digested properly, it doesn't get into the bloodstream to go with the insulin even if you feed a lot of it. Extreme skinniness is common with these kinds of disorders, which is probably the first thing I would pursue.

Usually... unabsorbed food causes poop problems. How are his?

And then there are dogs whose blood sugar just wanders all over the place and no one really knows why. I was acquainted with a toy poodle who did this and who also needed very little insulin because he was so small. He was worked up extensively at a vet teaching hospital and no one could find any particular cause for it.

I have often wondered if these dogs don't have an unstable hormonal/cortisol system. There's no name for such a disease but that doesn't mean it doesn't exist.

If Alfie turns out to have nothing else going on and is just a world class wobbler, you can eventually get used to that. Patty's Ali is an example of a dog who just isn't all that stable blood sugar wise and after trying literally everything, she has sort of "gotten used to it."

You can find a dose that works as a base amount that keeps him out of low blood sugar territory and work with that.

If you can manage to have some testing done, a handful of blood tests would sort out some of these questions - Addison's and Cushing's require a cortisol blood test and there are blood tests for the GI disorders and for chronic pancreatitis.

He could be tried off of insulin too to see if he is producing any of his own.

Natalie

[diggydog]

Re: Alfie's Story so far....

Every1 say hi to my vet who has been on reading about Alfie

Alfie is 7now and in all the time I have had him he has never like to swim in water and generally aviods it.
We were out walking today and Skye dropped her ball which rolled into the canal and she was too scared to go and get it so I figured thats just another lost ball. A couple of mins later I looked round to see Alfie swimming in the middle of the canal with the ball in his mouth. It was too cute for words!

[Patty]

Re: Alfie's Story so far....

Awe...that's too sweet. Did Alfie have lower blood sugar later from it? A swim will drop Ali a good bit.

Welcome to your vet!

Patty

[diggydog]

Re: Alfie's Story so far....

Not it really didn't make any impact on his blood sugar and to be honest he was straight in to get his ball then back out again. He must have only been in for 30 seconds lol
I did throw it back in for him but he looked at me like I had lost my mind almost like he was saying my god woman I JUST got that out and promptly walked off in the other direction leaving the ball where it was in the middle of the canal Typical!

[Patty]

Re: Diggydog

I can just picture that expression...too funny

[diggydog]

Re: Diggydog

Alfie really LOVES eating rabbit droppings and I noticed him eating a lot today. Is this likely to have a huge impact on his bg?

Another very cute story from this weekend-

Alfie as you may know came from rescue and ever since I got him he has never liked any other dogs apart from Skye. My best friend got a puppy and was really keen to start walking with us and so we started meeting every weekend for a walk when Roxy her white boxer was old enough to go out.
The first few weeks Ruth & Roxy had to walk around 10 paces in front of us to stop Alfie acting like a maniac on his lead and each week we gradually got to walk closer together. Its now been a year and my friend had a baby about 4weeks ago and I started walking Roxy for her to help her out.
I can now pick Roxy up and put her in the car with Alfie with no problems and for the first time ever today after our walk we all went into Ruth's house for dinner. All dogs were watched very carefully as baby Robbie was on his play mat on the floor.

After the initial sniff around the house and sniff of the baby all 3dogs settled down and were comfortable enough to lie down next to each other and go to sleep
Nothing beats seeing a 32kg boxer snuggle up next to a wee 6kg border terrier. A year of hard work really has been worth it for that picture today!

[diggydog]

Re: Diggydog

Just wondering if an increase in food can slow down over all digestion time?
I have increased Alfie's food again but noticed that his bg is taking longer to respond?

[peggy0]

Re: Diggydog

It depends on the type of food, I've found. If you add carbs, then yes, as long as the insulin dosage can handle the increase, you will see the food lasting longer. That is why we suggest adding pumpkin, or oatmeal or sweet potatoes to flatten curves

[Patty]

Re: Diggydog

By the way, I loved the Roxy and Alfie story

[diggydog]

Re: Diggydog

The Roxy & Alfie story just keeps getting better

After our morning walk today we went back to Ruth's for a well deserved cuppa. Roxy was playing with a ball (even tho she walked for an hour - I swear that dog never gets tired) Alfie kept moving closer and closer to Roxy, stopping and sitting every time she looked at him. Once he was close enough he was acting all cute and rolled onto his back, the second Roxy got up to sniff him he sprung up grabbed her ball and ran off with it. As he is so small he hid under a table with it so Roxy couldn't reach!
Roxy lay down at the table and the next thing Alfie rolls the ball out to her and then she nudged it back.
Ruth and I sat in total silence for about an hour just watching them

[Patty]

Re: Diggydog

Oh my goodness, that's hilariously sweet