Nima's crazy journey

[parisa]

Re: Nima's crazy journey

Hi Riliey and Mo,

I got the Alpha Trak 2 today and I love it.

I got in a bit of an argument with my mother. I told her that I wanted to do a curve on Nima tomorrow and I told her that he will eat in the morning at 7 AM, I will give him his first 14 units of NPH then, and then I'll do the curve all day long. I am under the impression that he can't eat until the curve is done at 8 PM. To me, I don't understand the point of the curve if you give the dog food in the middle? Since he is trying to gain weight, she wants to feed him in the middle of the curve. Can anyone give me advice?

[CraigM]

Re: Nima's crazy journey

Hi Riliey and Mo,

I got the Alpha Trak 2 today and I love it.

I got in a bit of an argument with my mother. I told her that I wanted to do a curve on Nima tomorrow and I told her that he will eat in the morning at 7 AM, I will give him his first 14 units of NPH then, and then I'll do the curve all day long. I am under the impression that he can't eat until the curve is done at 8 PM. To me, I don't understand the point of the curve if you give the dog food in the middle? Since he is trying to gain weight, she wants to feed him in the middle of the curve. Can anyone give me advice?

You're both basically correct. You need "curve day" to be a typical day. If you would always give a mid-day meal / snack then that might not be totally wrong either. But then you would want to do a full 24 hour curve because you probably wouldn't get up at 3AM to give a mid-night meal. We are trying to determine the correct insulin dose, and changing the amount of food, time of food, time of insulin would mess up the curve.

For gaining weight, possibly a better plan would be to add a little more food at the normal meals. Of course you would need to curve again (to reduce the insulin) in a month or two after he gets to the desired weight.

"Curve day" should be as typical as possible: no longer walks than normal, no home repairmen causing him to get worked-up, no unusual trip to the dog park, etc. I wasted many "curve days" when in the mid-afternoon the grandkids came over and got Annie worked-up

My theory.

Craig

[CraigM]

Re: Nima's crazy journey

Just came in from my daily walk / exercise and I was thinking about Nima's desired weight gain. If his BGs have been mostly 300+, he might not really need additional food if you can get his BGs down into the 100-250 range. As you know, he needs "proper" insulin to go along with his food/glucose. If there isn't enough insulin to work with the food/glucose, the glucose gets filtered by the kidneys and gets disposed in the urine (hopefully outside and not on your floors). Increasing food might not have him gain weight, just make bigger puddles to expel the unusable glucose in the urine.

So unless he is VERY underweight it might be better to skip the snacks and concentrate on getting the BGs into a better range. Then, if he still needs to gain weight you might increase his meals & a tiny increase of insulin?

Craig

[k9diabetes]

Re: Nima's crazy journey

Actually, your vet may be adjusting insulin faster than I would recommend - I almost never think a 2 unit increase is a good idea unless the dose is quite large.

A dog is considered "resistant" to the effects of insulin at 1 unit per pound but the most common dose for a diabetic dog is closer to 1/4 unit per pound. It varies a lot from dog to dog and it's easy to overshoot the dose if you don't proceed slowly.

Our 60-65 pound dog needed only about 8-9 units of insulin per injection.

Also, the first response you see to a dose of insulin isn't necessarily the long-term response. Especially at first, simply having had high blood sugar can make the body somewhat resistant to the effect of insulin. When that happens, after they have been on insulin for a while, a dose that used to be about right can become more than they need. Also, there can be overlaps of insulin injections, and the effect of those won't show up in a day or two or three.

So paradoxically, the fastest way to regulation is a slow methodical approach of small increases in dose with at least a week - and sometimes two or three weeks - in between dose increases so the body has time to develop a long-term response.

I've worked with a bunch of dogs who were rushed through the dosing process and wound up having to start over again.

Natalie

Thanks for your reply! He is doing tons better in terms of attitude, activity level.

I am curious if you have any in put, why does the vet adjust his insulin so slowly? Every week she's doing a curve and then only increasing by 2 units each time. I have read in multiple places that dogs can require 1 unit/1 lb so I don't understand why we're moving so slowly. Nima has never, ever, ever been hypoglycemic or anywhere close.

Thanks again!

[parisa]

Re: Nima's crazy journey

Hi Craig,

I completely agree with you about skipping the snacks. This is where it gets tricky: Nima was MY dog, I got him when I was 19 years old. I lived with my parents while I went to college, then when I moved out I wanted to take him with me however my parents became very attached to him and thus "he's our baby! don't take him". So I don't live with my parents anymore, I do go there everyday I have off (I only work 3 days/week) and sometimes after my 12 hr shifts to see him.

I have explained to my mom that food is no good if you don't have insulin to absorb the calories, but she feels like she needs to feed him when he's hungry and feels guilty starving him. He was 50 lbs when we first went to the Internist, he looked like literally skin and bones, absolutely horrible. He is 59 lbs right now and is still very thin, but looking much better. I should add that he gained the 9 lbs within 3 weeks of being on NPH v.s. Regular insulin.

I think once he has gained a little bit more weight my mom will be a bit better about understanding that 2 well measured meals a day is the way to go but trust me I am on the same page as you completely.

I also very strongly feel Nima was Cushing's. The hair loss on the abdomen, some on his inner legs (all the way from the thigh to ankles), a bit on his tail, the calluses on his elbows, boney head shape, and BGs that have been crazy really make me impatient for him to have the urine cortisol test done.

I am going to do a curve tomorrow and I will detail everything he ate and times for anyone who is interested and would like to perform input. Keep in mind he is takng antibiotics for suspected pyleonephritis and that he was only switched to 14 units NPH BID on Monday

[parisa]

Re: Nima's crazy journey

Thank you so much for your insight, I had no idea that she was actually going a bit fast. I guess I am thinking with my human RN brain a lot and I feel like we're moving too slowly.

[amydunn19]

Re: Nima's crazy journey

I would get Mom on board with everything - I know it is tough but if she wants the best for Nima, she needs to be stringent about the details. The weight will come back when the food and insulin get in balance. It really isn't a matter of food at this point. She could feed tons of food but if it is not working with the insulin, he won't gain much weight at all.

I am anxious to see the curve but with the insulin switch and the meds, it might not be info that will be as useful as under normal circumstances but it is worth doing.

[parisa]

Re: Nima's crazy journey

Amydunn19,

I agree, it won't really be beneficial but it will be interesting. I am definitely going to do a repeat curve once the antibiotics are finished. The good thing is by the time the antibiotics are done we'll know if whether or not to highly suspect Cushing's too.

I am going to try and have the vet talk to my mom one on one about the feeding times on Monday, I think this will really help hearing it from a professional v.s. her 27 year old daughter

[Auddog]

Re: Nima's crazy journey

Amydunn19,

I agree, it won't really be beneficial but it will be interesting. I am definitely going to do a repeat curve once the antibiotics are finished. The good thing is by the time the antibiotics are done we'll know if whether or not to highly suspect Cushing's too.

I am going to try and have the vet talk to my mom one on one about the feeding times on Monday, I think this will really help hearing it from a professional v.s. her 27 year old daughter

Hi again parisa,

I think I remember reading somewhere that hypothyroidism can cause hair loss you described earlier too. Has that been ruled out? I don't remember reading anything about that, but I could be wrong .

Sometimes hearing things from a professional can help alot. Bazzle and I still live my dad, and when Bazz was first diagnosed I had to drag him into the vet's office for them to help me lay down the law (ironicly enough, I'm 27 too). Sometimes I still have to remind him that even a few treats can mess up his BG levels.

I hope those antibiotics are making Nima feel better . Good luck with everything, we're here for you,

Audrey & Bazzle

[parisa]

Re: Nima's crazy journey

Hi Auddog!

His thyroid hasn't been tested yet either. They are going to that along with a repeat CBC, BMP, UA, UC, and then finally urine cortisol & thyroid. You are absolutely right, he also has signs of hypothyroidism, but with his skin stuff going on too, I feel like it's more likely Cushing's? This is just my hunch, who knows, I will let everyone know once his labs come back through for sure.

Nima's mood is so much better. He has been improving in every way possible (mood wise, stool formation wise, appetite wise, which surprisingly he never exhibited polyphagia)... except for his BG levels.

Funny we're both 27. I am an RN and my younger sister is a 3rd year medical student and we both explain things to our mom but she never listens...

[parisa]

Nima's curve

Hi all,

Below I am posting Nima's curve. It is not the best in terms of gathering information because 1. He is being treated for a UTI 2. He had some blood in his pee so we took him to the vet at 2:00 PM. 3. We suspect he has Cushing's as well (I reviewed his lab work and his ALP levels have been consistently very, very elevated 1288 when he was in DKA and then 822 when DKA resolved.)

The good news is he is now 61.6 lbs!

0645 AM 1 can of Royal Canin diabetic wet food, 1 can of "Hunk of Beef". 14 units NPH given

0745 BG: 468

0945 BG: 325

1000 1 can of Royal Canin diabetic wet food, 1 can of chicken (from Costco, it is only chicken and water, Internist recommended for weight gain)

1145 BG: 230

1200 walk, noticed some blood in urine.

1345 BG: 221, 1 can of chicken given. Taken to the vet for a UC & UA at 1400

1530 BG: 303, returned from the vet ate 1 can of Royal Canin diabetic wet food, 1 cup of Royal Canin diabetic dry food

I will post the rest of the curve in a bit but just wanted write this down before I pass out for a little nap.

I know this seems like a lot of food but Nima has a goal weight of 75 lbs, and he was 50 lbs as of 12/13/13. The Internist has approved his diet & snacks. We are going to try and get him closer to a twice day feedings with just 1 snack in the middle. Once we can do this I am going to perform a repeat curve on my own.

Thanks for your feedback, opinions, advice. You all are great!

[CraigM]

Re: Nima's crazy journey

Kind of hard to tell much from this day. You gave food at several times which probably affect the results. I agree that pure chicken might not make a rapid change in BGs, but I'm sure it will have some effect. Seems to me that anything that gets digested will eventually get converted into glucose??? Don't really know

At least you got some good practice testing

Craig

[parisa]

Re: Nima's crazy journey

Yes it's hard to get a good idea of what is going on when he is in the "need to gain weight mode". Before the NPH he wouldn't eat at all it was really bad (this was right before he went into DKA). Now he at least has an appetite and is putting on weight. The thing that I am happy about is that he is at least responding to the insulin somewhat, I was afraid for a bit that he wasn't responding at all.

[jesse girl]

Re: Nima's crazy journey

actually the 10 am meal probably kept his numbers fairly flat for the rest of the day off that hard drop from the beginning sometimes added snacks and meals can be helpful

just to put it out there this dose maybe to much when or if you decide to remove the extra meals . it is possible the extra meals maybe helpful

numbers actually look pretty good to start

[amydunn19]

Re: Nima's crazy journey

The numbers look pretty good, considering all the food spaced out throughout the day. It may be a matter of timing those meals too. It is very interesting - I have never seen that many meals spaced out during the day. When you do cut out those extra meals, he may not need that much insulin as jesse girl pointed out.