Help for little Piper?

[charity]

Hello! Our little pal, Piper, was diagnosed about 3 weeks ago after a severe bout of dka, nine days hospitalized, and another bout of dka. She is home now and generally doing well. It is all quite challenging, but we are doing our best!

Piper is 9 years old and a bichon/dachshund/cairn terrier mix. When they first released her from the ICU we were told to feed her twice a day - far more than she was used to eating - give her insulin twice a day and bring her in a few days for a full curve. She had almost no appetite and wouldn't eat the amount they wanted her to. They told us to half her insulin when she wouldn't eat, which we did. In two days she was back into dka.

She has now been home again for about 1 week. We were told not to test her glucose but bring her in for a curve on Monday. After last time, we went ahead and got the Alphatrak2 anyway.

She seemed to be doing quite well. Her numbers on the 16th were beautiful for her: 194,161,123,144,191

But yesterday she started at 273, dropped low quickly (60s), had a snack, dropped low in the evening again, had a snack, and then was up to 293 before dinner and bed.

This morning she started out at 436 at 7:15 , then ate breakfast at 8 and got her dose. By 9:40 am she was down to 147 and an hour later she was at 86.

I don't want to boost her up with snacks for no reason, but I don't want her to drop too far, so I waited another hour and got a 99, then another hour and got 80. At that point I figured she probably needed to eat and gave her a little snack. Her next check showed 264.

I am doing tons of reading, but really uncertain about everything at the moment.

Does anyone know why she might be dropping so quickly today?

How low is low enough that she should have a snack?

I don't want to boost her up out of fear of going too low. I thought about decreasing her insulin dose by a bit tonight (she was at 7 units, but the vet recently suggested 6 and she has been at 6 for a few days), but I also am not crazy about that morning number in the 400s.

Sorry to dump out the questions, just trying to figure it all out and so thankful for everything I have read here all ready!

[DebEsco]

Re: Help for little Piper?

I will be very interested to hear replies to this. I’ve been experiencing pretty much the same scenario since my toy poodle Romeo was diagnosed in Feb. we had some scary hypoglycemia occurring about once a week. I was advised on this forum not to feed him a high protein low carb diet, contrary to what vet told me. I switched him back to half his old grainfree kibble (sweet potato and bison) and half the high protein kibble. He has not had a hypoglycemic attack since. Though his numbers have not dropped as rapidly after his shots (he was hitting nadir two hours after shot, now it’s dropping slower) he is still going to 400s when it’s time for shot (this am 450) and I’m not happy with that. The vet internist told me perfect scenario would be to start around 300 and come down to a nadir of 100 six hours after insulin, with a daily average in 200 range. This is very hard, so we can commiserate together and share anything that works. I have an appointment with a second internist on June 5 since I didn’t care for the first one, who proudly told me he had not tested his diabetic dog in over a month! He did encourage me to do the two hour blood curve only once a week, which I think was good advice, but I always test before eating and shot which I think necessary at this stage.
Deb

[jesse girl]

Re: Help for little Piper?

Hi and welcome

Regulation does take time a patience . Anything below 80 is a concern for me with my jesse . If I see consistent numbers below 80 its time to reduce the dose

The higher fasting in the 400s maybe rebound with blood sugar bouncing off that lower number as a way for the body to protect itself from going to low

Lowering the dose sounds prudent and dont hesitate to go lower if still seeing low numbers

Now hypoglycemic events are rare in dogs especially for people that home test and not giving a terribly high dose of insulin . Most times when a dog is vulnerable could be during exercise during active insulin . The nine years since jesse has been diabetic she has not had a hypo event but her sugar has been low . Now you dont want to be complacent either

Your dog maybe still producing some insulin and may explain the ups and downs you are seeing . Is your dog spayed ? If not that can lead to regulation problems . How much does your dog weigh ?

Most find a path that works for them and find that new normal that the dog can lead a happy dogs life .

[charity]

Re: Help for little Piper?

Hi and welcome

Regulation does take time a patience . Anything below 80 is a concern for me with my jesse . If I see consistent numbers below 80 its time to reduce the dose

The higher fasting in the 400s maybe rebound with blood sugar bouncing off that lower number as a way for the body to protect itself from going to low

Lowering the dose sounds prudent and dont hesitate to go lower if still seeing low numbers

Now hypoglycemic events are rare in dogs especially for people that home test and not giving a terribly high dose of insulin . Most times when a dog is vulnerable could be during exercise during active insulin . The nine years since jesse has been diabetic she has not had a hypo event but her sugar has been low . Now you dont want to be complacent either

Your dog maybe still producing some insulin and may explain the ups and downs you are seeing . Is your dog spayed ? If not that can lead to regulation problems . How much does your dog weigh ?

Most find a path that works for them and find that new normal that the dog can lead a happy dogs life .

Thank you so much for the reply!

Piper is just under 9 pounds right now. She lost quite a bit of weight before and during the crisis she was in, but is eating well and putting it back on pretty quickly.

She isn't spayed, but that is on the agenda as soon as her team clears her for surgery. They would have liked to have done it immediately, but she was so tiny and unwell that they wanted to see her a bit better regulated and with a little more weight back on before doing it.

Originally, while still hospitalized, she wasn't very responsive to any insulin and they set her dose as high as they safely could. Last night I reduced her dose to 5.5 and she woke up with a reading in the 190s and is currently (12:30 pm EST) at 109. Definitely better than yesterday! I will check her again later to make sure she isn't dropping too low.

Thank you for sharing your wisdom and experience - knowing that you have made it 9 years is very encouraging!

[Raysaint]

Re: Help for little Piper?

My first thought is the dose is too high. 6.0 units for a 9 lb. dog is way above the normal starting dose, which is 0.5 units per kilogram (2.2 lbs. here in Canada.)
That would be 2 units.

And she may still be producing some of her own insulin, which will crash her even more.

I'd cut back the dose and make sure she has carbs in her food. Carbs are what offset and balance the insulin.

[jesse girl]

Re: Help for little Piper?

My jesse was diagnosed with a uterus infection and thats what they said that was making her sick so she had emergency surgery ( basically spaying her ) not realizing she was DKA and had pancreatitis and surprisingly she survived

A intact female would be very difficult to regulate do to hormones raising and lowering the need for insulin depending on the cycle

There has even been a return to normal after a spay and not needing injected insulin . With that period of good sugar you may point to that in your dogs case but like I said its rare

The larger dose may point to hormones of being intact but like raysaint suggested that can change on a dime and this dose could be to much and could be now

Glad you will be testing sugar at home because there can be some ups and downs until you get your dog spayed

[charity]

Re: Help for little Piper?

Yes! She was exceedingly puzzling for them at first because she seemed almost unresponsive to any dose across multiple types of insulin. She finally responded to 7 units, but the dose has been decreasing over the past week or so. Yesterday she went into the vet's for her first curve. We've been doing it at home, but because her situation had been a bit tricky they want to monitor her, too, right now. She dipped into the 60s with them at 5.5 units, so they had us scale back to 4.5. She seems to feel splendid and ran and played in the yard this morning. She was at 146 before breakfast and is now (12:00 pm) at 90.

Thank you for the advice about the importance of carbs. It is hard not to see them as the enemy at first. I returned her to her original grain free food mixed with a little high protein wet food instead of the extremely low carb food we were pushing her to eat. Seems to have helped already! Thanks again.

[charity]

Re: Help for little Piper?

Thank you so much for the response! At your and raysaint's advice, I switched Piper back to her old kibble (similar to the one you mentioned) along with a little high protein. She definitely seems to feel better.

I'm sorry things have been complicated with your little fellow! It can all feel just so uncertain.

[DebEsco]

Re: Help for little Piper?

My vet told me to give Romeo low carb food too. I had all kinds of ups and downs and several hypoglycemic episodes. Advice here convinced me to go back to his regular food. He feels much better, his swings are not as wide now and no more hypoglycemic emergencies. Thank God for the creators, moderators and contributors of this site. Wish vets were as knowledgeable.

[charity]

Re: Help for little Piper?

Just a quick update for you nice people who gave advice for our Piper girl. She is doing well and is just full of energy almost all the time.

We have her on what seems like a good schedule and we are still learning the ins and outs of adjusting her insulin ourselves. In general, she has really decent numbers at about 1.7 units.

Our main issue right now seems to be the duration of Vetsulin action. She can have a tremendous day of great BG readings, but usually 1 to 3 hours before it is time for her next dose, she starts reading in the 300s or 400s. Does anyone happen to know why the Vetsulin efficacy might seem to end too early?

[jesse girl]

Re: Help for little Piper?

I am not sure it ends early or just other processes occurring to end it like the bodies internal sugar mechanism . I have come to find out with jesse that rebound is quite common and maybe for many reasons not totally known . Allot of things about K9 diabetes is not fully understood . It could be the dose being so small that it doesnt last . It could be the dose is a tad to much and the body rebounds . Sometimes you can add a carb or a grain type food that can mute that spike but it takes experimentation

Injected insulin is nothing like the natural process where the body can call up sugar or insulin on demand . Injected insulin is a time released process and the body can only do so much to balance that

now you could see a more muted response over time with the spike . My jesses spike lowered over time to mostly the mid 200s but on occasion she can be in the 300s and she has been fine for 9.5 years diabetic

[Raysaint]

Re: Help for little Piper?

And remember Vetsulin is not all long acting, so it won't necessarily have the same strength pattern/duration as NPH.

My dog, on NPH, always rises 3-4 points (Canadian) after his nadir period ends, around 3:30 p.m.

And as we all know, every dog processes insulin differently. And sometimes there's no fix, the numbers you have may be the best you can achieve. Good news is he has good numbers for most of the 12 hours, so it's a good average.

Does his nadir allow for any slight increase? And you mentioned you're learning how to adjust his insulin. Dogs usually do best with a consistent dose.