Peggy's Forbin is gone... April 14, 2010

[We Hope]

Re: Peggy's Forbin - I'm so so stressed

Peggy,

Once you have a rebound situation, it will take a few days for the counter-regulatory hormones to settle back down again, even after you lowered the insulin.

When blood glucose takes a nose dive, the body has a built-in automatic response to try to save itself. It can't recognize that the bg's might not be low enough to need to do this; all it sees is that the bg's are going down at a rapid rate, and then the counter-regulatory hormones are sent out.

These hormones, cortisol among them, raise the blood glucose. This is how you could be seeing Forbin at 76 one hour and then over 200 the next one.

Even though you've lowered Forbin's insulin, these counter-regulatory hormones are still in need of settling back down to their normal levels.

So perhaps it's good that he goes in Tuesday, because when the doctor sees Forbin, he/she will be seeing him after they've reverted back to their normal levels.

Kathy

[peggy0]

Re: Peggy's Forbin - I'm so so stressed

Hi Kathy, Thanks, sure hope so. I should leave him then at the lower dose for a few days even though its high? I tested for ketosis and its negative. Thanks much!

[We Hope]

Re: Peggy's Forbin - I'm so so stressed

Peggy,

I think if possible, until Forbin goes in, I would try to leave the insulin where you have it. Am fairly sure that you discussed what happened with the new vet when you got the appointment and told him/her what you needed to do for Forbin re: cutting the dose in half yesterday.

The thing about being high for a little while is that it's less dangerous than being too low. You can be running high for a little while and not have any permanent ill effects from it, but too low can be a disaster.

As Forbin's counter-regulatory hormones start settling down some more, you may see that his bg's lower too. Not lower to the point where they're perfect or to the point where he's getting close to being too low again, but you probably will see them go down somewhat and "level" off.

One of the secrets with insulin is to be consistent with it. We had a weak vial of the old Lilly pork insulin around the time they were discontinuing it. There was no Vetsulin in the US yet, and pharmacies didn't keep pork insulin in stock. They would need to order it for you, so you couldn't just go to a drug store and pick up another vial.

What we had was the old vial of insulin which the new one was replacing because we knew it wasn't 100% potent any more. We went back to using the vial which was going to be discarded because we believed it was more potent than the brand new one. (Tested a draw from it and found the new vial was 45-50% potent).

But what we didn't know, was just how much potency was left in that old vial we were getting ready to throw away. That meant that we couldn't raise Lucky's dose because we might have sent him into a hypo if we did, not knowing that. So we had no choice but to stay at his usual dose he got when the insulin was 100% potent.

It took about 3 days for his bg's to calm down after going back to that old vial. They were high enough that he had panting--a visible sign of his post meal spike 2 hours after eating. Every time I fed Lucky and gave him his insulin, I would see that the visible signs of that post-meal spike were getting better--they were gone on the third day back to the old vial.

We had to work with less than potent insulin and no way to raise Lucky's insulin safely, but we got him back into line until I could order a new vial--we did it with being consistent with that less than potent insulin.

You, your new vet, and Forbin may have to work your way up the "insulin ladder" again, but I think this time the increases won't be such large ones at one time. It's much better to make increases a little more frequently, with an eye to safety, than to be making such drastic, large ones.

Kathy

[peggy0]

Re: Peggy's Forbin - I'm so so stressed

Yes he thought Forbin would be fine until Tuesday. He's acting normally; and every 2 hours ducks somewhere so I can't find him. Smart doggie. Thanks so much for the great advice kathy.

[We Hope]

Re: Peggy's Forbin - I'm so so stressed

Forbin thinks you're mistaking him for a pincushion!

Kathy

[peggy0]

Re: Peggy's Forbin - I'm so so stressed

He does. His latest reading indicates his BG is going up again. I'm very nervous about feeding him when its going up knowing he spikes. He isn't scheduled to eat for another hour. This is going to give me ulcers!! Do I adjust his food or just keep going?

[We Hope]

Re: Peggy's Forbin - I'm so so stressed

Peggy,

I think you're feeding and giving insulin every 12 hours, right?

In order to have consistency give you a hand, you also need to keep feeding Forbin at the usual time.

Try keeping to the insulin dose you've cut back to and the usual meals at the usual times.

Is what's worrying you the idea that he will spike and perhaps have another low? If that's what you're thinking, you can breathe easy because by cutting the insulin as you had to last night, the "threat" of Forbin going too low isn't there.

Kathy

[peggy0]

Re: Peggy's Forbin - I'm so so stressed

Yes he is fed every 12 with insulin at the same time. I'm not afraid of low i'm afraid given its 462 that it will spike and be so high

[eyelostit]

Re: Peggy's Forbin - I'm so so stressed

Peggy, I know how concerned you are, till his body settles down leave things be as Kathy mentioned, I don't think you are going to get a low tonite.

[peggy0]

Re: Peggy's Forbin - I'm so so stressed

No I'm not worried about low; it's high I'm worried about given the current 462

[eyelostit]

Re: Peggy's Forbin - I'm so so stressed

Somewhere something got explained to me it went like this.

If you get a headache and take an asprin the headache starts to ease up (Onset) then the headache goes away (Peak) but the asprin is still in your system (duration)

If we still have the headache a human can take another asprin, but insulin is much more different than asprin.

Some of the prev insulin from the higher doses can be still in system, thats why insulin gets lowered.

Things should look better tommorrow or by say Saturday.

This little info helped me a long time ago, as it took me awhile to understand things, its stressful at the beginning, but it will all work out, I can just see you more relaxed in a few more days, and no doubt next month you'll feel even better. The vet put you on the wrong path, now we are going back that path and on to the new one

[peggy0]

Re: Peggy's Forbin - I'm so so stressed

Ah that makes alot of sense I'm usually calm. I took care of my mom for two years and she had congestive heart failure and I was pretty calm after the first episode. Of course she could talk to me Forbin is acting perfectively normal. I'll get through this with all your help. Thanks again

[eyelostit]

Re: Peggy's Forbin - I'm so so stressed

Anytime, take care

[k9diabetes]

Re: Peggy's Forbin - I'm so so stressed

Personally, I think a one-half reduction of the insulin is too severe, especially with the highs now.

We can't really say with certainty that the BG is high from rebound... with half the usual insulin the BGs would be high without any counter-regulatory hormones in play so BG in the 400s on half the insulin dose makes me think there isn't a rebound crisis here.

Chris (and I believe other dogs) almost never rebounded from lows. And I could give Chris half his insulin if he didn't eat anything.

I would opt for at least 3/4 of the usual insulin dose with food. Three quarters of the insulin dose should be enough of a reduction to avoid a low in the future.

I don't like seeing him on such a low dose of insulin for days at a time. I could see cutting the dose in half right after a low but then I would bring it up further.

Those of you who have known me a while know I personally believe that rebound is not a given and not as common as sometimes believed so it may be my prejudice talking. But if Forbin was rebounding and getting his food and getting only half his insulin, I think his BG would have been 500 plus.

Natalie

[peggy0]

Re: Peggy's Forbin - I'm so so stressed

It was 466 at 6am. It may have been too low. I'm increasing it a bit today and see the curve.

Update very disturbing

530 466
600
730 477
1030 494
1230 HI
130 HI
300 HI
430 375
600 323