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  #31  
Old 01-24-2010, 11:10 AM
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Arrow Re: Taylor - Road to Regulation

Pat - no reprimands here! Observations, yes. I really think you're doing a top-notch job - don't want to shoot yourself in the foot, at this crucial time! (Um, I guess it's not recommended to shoot the dog's insulin into your foot anyway; ha!)

Looks to me as though you have a good handle on what you're doing, largely - I do feel some concern for the cumulative effect of rapid increases in dose.

What's the date on which you have to board Taylor? No guarantees he'll be able to climb the steps by then, though; we can all wrack our brains in case we can think of some kind of solution to that difficulty. But I think it would be okay for Taylor to be running a bit high at the time you have to board him for a few days. Surely that's better than being on the low side with his BGs at his nadir (low) time of day.

How is Taylor feeling now? Better, I hope! As for you, Pat, I admire your bravery and determination. I might easily have had a heck of a hard time doing as well as you're doing now! I'm just extremely fortunate that my vets are so good - and that I haven't had the associated pressures you have, with your husband and your job.

I'll be watching for your further reports. Likely, sending my friends to watch, too!

Sun, 24 Jan 2010 10:08:04 (PST)
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  #32  
Old 01-24-2010, 12:21 PM
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Default Re: Taylor - Road to Regulation

I believe its too early to tell. I'd want to give one dose several days before drawing conclusions, but that big of a spike after seeing a 100 is alarming to me I'd do as Carol said and stick with 27 for at least 3 or 4 days. I don't know NPH that well as I'm just converting, but given its powerful, it would worry me to see that spike. We're all learning this insulin together. Thank goodness there are experts out there. Good luck
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  #33  
Old 01-24-2010, 12:38 PM
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Default Re: Taylor - Road to Regulation

I think 28 units is too much. I would go back to 27, maybe 27.5 at most.

The amount of insulin you can give is controlled by the lowest blood sugar reading, which in your case is in the mid 100s - Congratulations! .

Because any time you raise the insulin dose, all of the numbers drop, not just the high ones. So what was 156 might drop to 100. That would be okay. But what if it drops to 60?

You have to tackle the spike in blood sugar after eating with other tactics, not raising the insulin dose.

One of the ways this can be done is to give a tiny bit of Regular insulin with the NPH.

If your dog will eat reliably, you can give the insulin first. It is, of course, a risk of then he doesn't eat.

You can also, if you don't mind doing two injections, give half his insulin first, feed, and then give the other half.

I actually think that, given the surgery deadline, I would go no higher than 27.5. I would sit at that dose for a while, at least a week, and see if the response is the same.

If 27.5 brings his BG down a little bit - nothing under 100 - then I would use either 27 or 27.5 while he's being boarded. Probably just 27. It wouldn't hurt to run his blood sugar just a little higher than you'd like when he's not under your supervision. That would be safer than a potential low.

This really looks good. We could try tweaking to get rid of the spike after the surgery is done and everyone is home and back in their routine.

Nice job of getting him there quickly! I think the vet will be pleased with this.

Natalie
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  #34  
Old 01-24-2010, 03:49 PM
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Default Re: Taylor - Road to Regulation

Thanks everyone. At 5pm he was 212 with the contour meter, gave food and 27.5 units. I checked again at 5:25pm and he was 201 with the contour and 225 with the one touch ultra mini. It looks to me as if the food just got ahead of the insulin this morning. I was having even worse morning food spikes on the vetsulin. Good advice to cut back on the dose while he is boarded. I still have a few weeks left to figure things out. I also liked the 2 morning shots idea. I don't feel like I know enough yet to try regular insulin.
Pat
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  #35  
Old 01-26-2010, 03:50 PM
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Default Re: Taylor - Road to Regulation

I need more help with the switch to nph. Since Sunday pm I have given 27.5iu twice a day, and today at 6am got a pre-meal reading of 92. I was still thinking this is okay because it is probably really about 80 pts higher. So I went ahead with a 27.5iu am dose. Now at 5pm which should be his nadir I get a 261, which is a lot higher than it has been running, so I dropped the dose to 26 tonight, in case I am getting some sort of rebound. I’m thinking of staying at 27 am/26 pm the rest of the week and doing a curve on the weekend. Does this sound okay? Today was actually one of Taylor’s better days, as far as how he was acting.
Pat
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  #36  
Old 01-26-2010, 04:28 PM
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Arrow Re: Taylor - Road to Regulation

Pat - it's really hard to tell, with ONE reading (that 261 at the time that should have been Taylor's nadir), whether it's just one of those flukes with BG levels (that is, a spike for which we have no explanation), or whether, indeed, that nudge up by half a unit twice a day is setting off a rebound situation.

I guess the only way to find out is to continue testing, and perhaps it would be safer at least to drop back to the 27 units twice daily. As I think about it, I'd probably do that, if it were Kumbi (except HIS dose would be a lot smaller, because he's a small dog; haha!)

As long as you remain aware that it's not at all uncommon to have a spiking BG at some time during a day, or perhaps over a period of two days or so. We recently had this with Kumbi, who, on a day I'd just raised his dose by half a unit (morning and night), suddenly showed up with some high readings - look familiar?

Friday, 18 December 2009
Kumbi had been drinking a lot of water the last day or two; I had a curve on him from 14 December. On 18 December, in the morning, I raised his dose from 6.75 to 7.25 units of Novolin-NPH, twice daily, a.m. I feed at 6:30 a.m. and p.m., and shoot at 7:00 a.m. and p.m.

Kumbi was very restless in the evening, so I did a spot checK:
20:16 - 29.7 mmol/L = 535 mg/dL

Later the same evening:
21:32 - 30.2 mmol/L = 544 mg/dL

And later:

23:28 - 26.3 mmol/L = 474 mg/dL
Rellief! He was on his way down.

Saturday, 19 December 2009

02:04 - 27.3 mmol/L = 492 mg/dL

Geez; going up again, but not drastically. Kumbi is typically on the high side at morning fasting - perhaps he has Dawn Syndrome.

Continuing, Saturday the 19th; fasting:
06:26 - 25.1 mmol/L = 452 mg/dl

Starting DOWN!

08:24 - 25.3 mmol/L = 456 mg/dL

WALK, 08:30 - 09:00, low excitement
Kumbi trotted out well, not tired.

And then, after the walk:
09:04 - 21.1 mmol/L = 380 mg/dL

Consderable drop. Kumbi has always dropped considerably on a walk.

VERY interesting - see the resemblance to your experience with Taylor?

Next day, I started on a new vial.

But no sign of lows, and this all straightened out by the next day, and Kumbi stopped drinking so much water, too.

He was still running on the high side the rest of the day, but settled the next day or two, into his normal pattern.

In short, I don't believe that was rebound. Perhaps Taylor's high reading also wasn't the result of rebound, but a bit of a fluke. With Kumbi, there's always a CHANCE he could have snatched something up along the verges as we walk; he is REALLY fast. Or he might have caught some crumbs off the floor or something.

He's been very settled since, and still running slightly high, so after my next curve, of 17 January, I raised him another QUARTER-unit. Not a half. This NPH insulin is really powerful stuff!

Good luck with Taylor, and I WILL be here watching!

Tue, 26 Jan 2010 15:25:55 (PST)
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  #37  
Old 01-26-2010, 07:31 PM
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Default Re: Taylor - Road to Regulation

Carol, thank you for easing my mind. I guess I am expecting too much too soon. I have probably reached my limit for unsupervised changes and will just sit tight at 27iu for awhile and give the poor guy a break from constant tests.
Pat
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  #38  
Old 01-26-2010, 07:49 PM
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Arrow Re: Taylor - Road to Regulation

Hi Pat,

In the middle of Kumbi's Sacrosanct Time here; just enough time to drop you a note before I fix his insulin injection!

My vet asks me to limit testing for Kumbi, who is considerably stressed by any form of Procedure, not just BG-testing, and BG-testiing is, for Kumbi, his least-liked Procedure.

So, my vets arrange dosing, as far as possible, to maintain good glucose control, yet to minimize the amount of testing necessary for safety.

So, I really like your idea of sticking with 27 units for the time being, as that does seem a safe level for Taylor. And minimizing testing for a time - giving Taylor a break - is something I really like, too!

Do keep us posted on how things go! Rooting for you!

Now off to collect Kumbi's insulin - ha! - I'm finally at a half-unit dose instead of the prolonged series of quarter-unit doses! Half-unit ones are just a bit easier to measure (on a syringe with half-unit markings, of course!)

Tue, 26 Jan 2010 18:48:38
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  #39  
Old 02-28-2010, 08:32 AM
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Default Re: Taylor - Road to Regulation

Taylor Update—Husband’s hip surgery went well and I ended up taking Taylor along and just running back and forth between car, motel and hospital. I think the change in routine and scenery did him some good. I found a second vet who has diabetes himself and he has helped me cut the diabetes monthly costs from over $800 down to $150. In looking back over the past three and a half months there are at least five things that would have made regulation easier and I wish I had known from the get-go:
1. The initial dose of insulin will likely be too low to show much of an effect. It may take several months to achieve control. Do not assume you are doing something wrong when you do not see immediate results, however, do not remain too long on an ineffective dose while your dog continues to deteriorate.
2. Take on the responsibility for management of your dog’s diabetes as soon as possible. Educate yourself quickly and use veterinarians (most likely more than one) as advisors.
3. Get a human meter with inexpensive test strips and learn to test. Cheap strips are important so you don’t worry about the cost.
4. Try regulating on the least expensive Wal-mart ReliOn Novolin N insulin first. If it doesn’t work you can always move on to a more expensive insulin.
5. Determine dog’s ideal weight, calculate calories to maintain this weight, and choose an affordable, high fiber, easily acquired food that your dog likes. Measure exactly and be consistent. The insulin can then be adjusted to work with the diet.
Taylor has stabilized for the past month at 82.4 lbs and is getting 1510 calories per day with 1 can W/D and 4 cups Science Diet Adult Lite Dry. I am using a Bayer Contour Meter which reads about 80 points low so this curve starting 02/27/10 is going to look a lot better than it is:
0600 125 6.9 1 cup dry and ½ can wd 33 units nph
0900 145 8.1
1100 143 7.9
1200 85 4.7 1 cup dry (will move this up to 1130 on Sunday)
1400 134 7.4
1600 133 7.4
1700 107 5.9 1 cup dry and ½ can wd 32 units nph
2200 131 7.3 1 cup dry
0600 126 7.0 1cup dry and ½ can wd 33 units nph
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  #40  
Old 02-28-2010, 08:57 AM
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Default Re: Taylor - Road to Regulation

Wow - even with the additional 80 points, that is a wonderful curve. No huge spikes or dips. Glad to hear Taylor is progressing so well and that your husband's hip surgery was uneventful.
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