Help.. Please:Dental Friday For Suzie

[MikeMurphy]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

daisy dog is an example how to stabilize an unstable pattern with a carby snack
slowing down a long steady drop with some added sugar from food

There are two things I noticed with Daisy:
She had a high fasting but nadir was good, so I didn't want to give her any more N. I would give her 1/4 unit of R along with her N and it brought her down, but a little too fast and she rebounded. I stopped the R, gave her a little carb snack around noon and she leveled off nice in the afternoon.
I do keep the R around in case if an emergency.

Daisydog does pretty much what you are suggesting. She adds a carby snack before her dog’s nadir and this helped to flatten Daisy’s curve and lower her fasting BG.

[Daisydog10]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

I know a lot of people don't like to mess with their dogs food, but in our journey I've noticed that I can change her bowl curve to a mountain curve just by adding a few grams of kibble. Quinoa and steel cut oats take her to the roof on 25g but brown rice and chana dal do not. 1 extra gram of kibble can spike her. She needs about 1g of carb midday for a decent fasting.

Then as Daisy has gotten rid of the fat and is all lean muscle, her metabolism changed. Then there's her age factor.

Lately, she's been spiking after a meal and her nadir is later. I'll lower her carbs by 5g at a time and add some protein and see what happens. She still gets her noodle and her fasting is good, but if she can't shake this in a couple more days I'll add just a few drops of R, not even near enough to hit the 1/2 mark line. Sometimes that will do the trick and reset her for some reason.

The good thing about a limited ingredient diet and measuring each ingredient is I can pretty much tell what ingredient it is and keep a track of it.

So nothing is constant with her, so I run curves, sometimes every hour instead of two hours, especially after she eats, so I can see how she's digesting her food. Sometimes just taking away a gram of kibble is all she needs.

I guess what I'm saying is, I look at her nadir and if her nadir is good, I work the food part before and after.

[amydunn19]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

Once Maggie started eating four times a day, her fasting numbers were pretty stable. Adding extra food is something that many frown upon but we did it out of necessity for pancreatitis. Adding the food did not create a need for more insulin in her case, but I don’t know if that is the case for most dogs. I feel like it is beneficial to experiment with food, but the testing can be problematic. Time and access to dogs during the course of the day may not be practical and for some dogs, intensive testing would not be a adequate quality of life. Mags was a willing victim as she loved attention and she was tough as nails. She did not show pain very often. Her frequent lows were just worrisome so I tested her more often.

[bichons9]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

Oh well, I can't remember "why" I am doing anything?? I thought someone said (Raysaint) that if insulin runs low or out, that is when the body releases the glucose causing the spike AND a very low nadir can instigate the BG high...SO, even though on the 12th I planned on only checking BG@ 6a,12p 6p,12a, suggested by DVM, I noticed changes and decided to start giving Suzie 25g chicken breast at low nadir to see if blood glucose might not spike due to body's glucose release??? However, I am a little mixed up now if my method is correct??? BTW, I have never noted chicken to raise the BG in a short time..maybe over a couple of hours or not at all since it's a pr-??? (but would use carbs if real hypoglycemia noted)..I may be taking in all the great info and getting it wrong???

[k9diabetes]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

In some cases, giving food to prevent a strong drop in blood sugar can "flatten" the curve because you are giving the body sugar when there's a lot of insulin kicking around looking for some.

It's a way, essentially, of conserving insulin for later.

If the insulin gets into the blood stream and there's no sugar to go with it, it gets used as it drops the blood sugar hard - a lot of it gets used when it's not really needed. Then later, when sugar does make it into the blood stream, there's not much insulin left to deal with it.

The flatter curve may all be high - that's okay. Because if the curve is relatively flat, you can then increase the insulin dose to bring all of the flatter levels down.

What you're effectively doing is matching the sugar supply with the insulin supply so it all gets used efficiently.

This works well if the dog fairly consistently has a sharp drop at more or less the same time every day.

If the blood sugar is erratic, I think it would just complicate things.

So I would reserve this for a dog whose body has a demonstrated pattern of going low at, say, 7 hours after food and insulin injection. The meal could be broken down into a smaller meal and a snack, for instance, given some time, maybe an hour or two, before the blood sugar usually bottoms out. So smaller meal with insulin, rest of meal at hour 5 for blood sugar that bottoms out at hour 7.

Without a consistent pattern, you would just muddy the picture even more.

For some dogs, inconsistent is their pattern. Could be for a lot of reasons, nearly all outside of our control.

Chris used to roll through waves of a few weeks at a time and we adjust his dose by a unit as he crested the top of those waves of blood sugar levels and started toward the bottom of them. His dose was never markedly different, just a unit one way or the other.

Natalie

[jesse girl]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

I just give jesse a small milk bone . Something like chicken and maybe vegetables just doesnt get the sugar you need to flatten out a curve . So you need a food that does that and regular carby milk bones can do that

[bichons9]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

I just give jesse a small milk bone . Something like chicken and maybe vegetables just doesnt get the sugar you need to flatten out a curve . So you need a food that does that and regular carby milk bones can do that

Thanks jesse and Natalie..I think I made a mistake or am giving the wrong snack/meal at wrong times since ..Suzie's nadir peaks at 4 hrs or 8 hrs (no added food) so...tonight maybe I'll let a BG-10 pm=111 await to see what the 12a BG is..and then the 2 am BG...At 3-4 am the insulin is finished. No chicken unless too low BG...or when would I give the milkbone?I'll have to see real results tonight "without" giving food to prevent next lower BG (unless essential)

[bichons9]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

So..if fed at 6 pm...cut in 1/2 and give part at 6pm and then part at 8 pm if her nadir is 109 or wait until it goes lower 2 hours before 12A...and same during day? I have been giving her full meal @ 6p and 6a..and THEN, 25 g chicken AFTER the first low nadir and sometimes after the 2nd...Also, if after 2 am the BG goes up to late 390s by 6a/6p..I guess I would have to raise the insulin but if it doesn't work past 8 hours?? So you think that insulin if not used up during the first 8 hours due to the full meal, some insulin would still be available for the last 4 hours? It doesn't get used up? Sorry that I am so confused..May e I'll cu oit the chicken snacks or try the 4 meals instead of 2 before I do anything. All my DVM said was to raise her to 2.8 u Vetsulin. So, would giving 4 smaller meals affect her dose of insulin" Would her nadir drop more? Don't worry..All of your info is helpful..I will think about all of this before I do anything..Thanks again!!!

[jesse girl]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

Normally you would not give a piece of chicken for lower blood sugar in the hopes to raise it quickly . You need something that is a bit more sugary . I understand you mindset thinking that sugary is bad but not for low sugar . It helps to raise it more quickly or stop a drop from continuing lower . Actually with jesse i might take a milk bone and drizzle some honey on it .

Now with a typical curve where the nadir (lowest sugar ) is at about hour 6 with a fairly hard drop in sugar and a subsequent spike in sugar a snack like a milk bone can quiet that spike a bit to not be so large and helps sugar to be a bit more stable

Milk bones may not be on the list as a health food . I guess you can call it the potato chip for dogs . As you know in the medical world sometimes we have to give or do things that are not really healthy for us or our dogs but they help with something that is much worse for us like chemo for cancer . Now something like a milk bone or cookie isnt close to something like chemo or taking blood thinners as far as having a negative affect on our dogs body but can have a dramatic affect preventing a hypoglycemic event or getting blood sugar more stable as blood thinners prevents stroke

sometimes we have to do things that we may not consider healthy to prevent something that can be much worse

[bichons9]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

Thanks jesse girl..I am NOT a health food nut and don't care about sugar, cookies, etc..whatever works. Suzie eats chik, gr beans and (partial) Rubie Stewbie) because she refuses all other foods. ANYWAY, I may be too lacking in cognition to understand. So, main issue is high FBG that are a little lower since raising insulin...but still high 300's..I can't find a book...So..if 12 MN nadir is 109 or 93 or whatever, next might be even lower..so this drop causes body to respond by producing sugar to compensate? If you give Suzie a few carbs , the body will know NOT to produce the glucose even though nadir was reached already? If there is no insulin left after 2 am, what happens to the sugar? OR does anyone think that the Vetsulin can be made to stay in the system longer than 8 hours by not using it up during the active part after eating> The intermediate portion does not work past 8-9 hours.You all do not have to bother with my confusion. I need a "real" article or book or brain to apply the physiology. My DVM does not know this stuff. He reads the inserts on the vial...I will call Merck again so they can tell me "Nothing"..You all are great to put up with my ??? ...Maybe someone could simply tell me what to do based on Suzie's numbers??? Have a great day. To sum up..if I did not worry about the FBG, there would be no issues..and to raise until flattening out ..I don't know how to do this. If all BG's were in 200's that would be fine or even a little higher..but HOW? 1-Raise the insulin to lower FBG... 2) raise the food to prevent hypoglycemia..or accept the high FBG..DVM said "It's ok to have high FBG 2 hours a day." "Try 8+ hours.."

[MikeMurphy]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

Hi Fran,

If you look at Suzie’s curves and daily BG numbers, they are all very similar. The insulin, especially the fast acting component of Vetsulin, is outpacing her food.

The issue is how to slow down the insulin and flatten out the curve. As others have mentioned, one way to do this, without changing her diet or insulin, is to give her one or several carby treats sometime BEFORE her nadir. Hopefully, this would slow down the drop in BG and result in flatter numbers and possibly a higher nadir. This could allow the insulin to last longer, eventually resulting in lower fasting BG. The higher nadir would also allow you to slowly increase insulin.

[jesse girl]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

From the curves mike posted the nadir is at different times . If you gave a carby treat after the rise it probably wont do much good .

So try a small milk bone at say 10 am maybe even drizzle some honey on it . The goal is to slow down the drop or stop it and see if the fasting number is lower if so continue to give the snack and keep experimenting . this is not a change in the routine unless it works

Now if it does work but the morning fasting is high you may have to give a snack at night

Timing maybe important . Now if your dog is higher at snack time there is really no reason to give it but for jesse she expects it and i cant say no

the nice thing at least for jesse is she can be decadent for one moment in the day

[Lolo]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

I’m having the same issue as you, Bichon. My Lucy’s curve looks a lot like your 2/18 curve except she’ll often be much higher by 3p and occasionally goes over 500. She was on 70/30 (similar in theory to Vetsulin) and we switched to Novolin N last week just as an experiment to see what happened. What happened was it looks pretty much the same but she doesn’t drop as quickly/steeply in first two hours. It’s had no positive impact in lowering her fasting numbers though. I ended up basically giving her a dose of N that was pretty much identical to the portion of N in the 70/30. She was on 12u of 70/30 and dropping too low... was seeing some 50s. Basically that’s 3.6u short acting and 8.4u intermediate. I’ve been giving her 8.5u N for about 5-6 days now and she’s still close to or in the 400s 3 hrs out from her next dose and ALWAYS over 400 at fasting. Her lows are in the 150 ballpark.
I finally caved and bought Levemir and I’m giving up on the intermediate and switching over tomorrow. The scary thing is I’m kind of winging it on dosage. The dr that put together a levemir dosage chart for me did it when Lucy was at a WAY higher level of 70/30. Basically double what she’s at now. Either we were overdosing her or she just had higher needs when first diagnosed. I’m going to almost halve her recs and basically going with 1/4 the current dose of N since Levemir is supposedly 4x stronger. I’ll giver her 2u and I’m crossing my fingers this levels her out. I’ll let you know what happens since I know it’s something you may be considering next.

[bichons9]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

Thanks Mike..You're right..all members have "tried" to ex-plain this to me. So, tonight at 9-10P??? I'll give her 28g R.S. since that is what has the carbs (lentils,blackeye peas,pearl barley, etc). The one time I did this, her BG shot up so much, I stuck with chicken if BG was just low 100's. If 28g RS doesn't work, I'll increase the amount at 11p or in am before day nadir..As always..Thanks all of you!!!! I understand the raising the nadir to increase the insulin..but I just don't know if the insulin sits in the tissue (while a carb meal is taken) waiting to be needed..We'll see...

[bichons9]

Re: ? Thoughts "Focusing On Nadir" to Decrease Fasting BG??

Oh MY!!! My brand new Levemir is in the fridge waiting for me to get the nerve to try it. My DVM knows nothing about using levemir so I have no protocol..I liked Lantus but it was worrisome too and I never slept..No sleeping on Levemir I would imagine!!I would be so very interested in all that your DVM said and what protocol he provided you!! Suzie is 5 kg so I have been warned about using it on a dog that small. How big is LoLo???