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  #111  
Old 05-03-2010, 06:02 PM
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Patty Patty is offline
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Default Re: Jessie, Min schnauzer just dx-ed

Kim,
I'm with Peggy, the 1:45p to 4:30p is suspicious of rebound. If she went quite a bit lower than 108 between those times, her counter regulatory hormones may have kicked in creating the high of 414.

I know we lost some "cred" with the folks before when expressed concern but I'd be concerned she could have gone too low this afternoon. But then we've never had a 4:30pm reading before either to know whether duration is just being cut short.

While these curves are not complete 12-hour curves, take a look at the range of numbers reported previously:
4/7 on 6u range of 208 from highest to lowest number reported
4/12 on 8u range of 28 points (she rose this day where other days she dropped)
4/26 on 10u range of 128 points
5/3 on 12u ranged of 306 points

Definitely progress in lowering bgs...but I'd like to see her on 11 units as Peggy said with those numbers. See what Natalie has to say
Patty
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Last edited by Patty; 05-03-2010 at 07:10 PM.
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  #112  
Old 05-03-2010, 08:27 PM
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Default Re: Jessie, Min schnauzer just dx-ed

On the face of just those numbers, I can't tell whether it's rebound or lack of duration or just a very sharply shaped curve where the insulin food balance is out of whack so it starts high, goes low, and goes back to high.

It is a great example of the kind of curve that would make a fructosamine test completely meaningless!

I'm thinking they might be very willing to give Jessie a snack in the afternoon. Based on this curve, that's what I would suggest to them if they were listening to me . A mid-day meal. Not too big, at about noon.

I know they will think you're nuts to tell them now to give a snack. But the joy of it might make them overlook that!

A snack at noon should in theory help level out the blood sugar early in the afternoon. And if a snack was given at noon, those afternoon readings would give us the answer to the rebound/duration question.

If rebound, the late afternoon readings improve by eliminating low blood sugar.

If lack of duration, the late afternoon readings get worse cuz there's even more food than before at a time when there's not much insulin action.

Curves at the vet don't always reflect things at home either, which is among the reasons I like home blood glucose testing. They are usually shut in a cage with no activity, nervous, bored... it's just not anything like the home environment / activity level.

If rebound could be ruled out, this would not be ideal but it could be lived with if need be. Probably a lot of dogs who aren't tested have curves like this. As long as the forays into higher numbers are brief, it's not the end of the world. But the trick, again, is make sure it isn't rebound and the stores of backup of glucose aren't being depleted by repeated emergency responses.

Natalie
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  #113  
Old 05-04-2010, 04:51 AM
frijole frijole is offline
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Default Re: Jessie, Min schnauzer just dx-ed

Quote:
Originally Posted by k9diabetes View Post
If rebound, the late afternoon readings improve by eliminating low blood sugar.

If lack of duration, the late afternoon readings get worse cuz there's even more food than before at a time when there's not much insulin action.


Natalie
So you are thinking a snack midday would lower that afternoon number? Not sure what you are saying regarding lack of duration. English please?

They feed her 1/2 c kibble morning and night and have been giving her green beans as treats. Are you suggesting a bit of kibble at midday? If so - approx how much? Its easier if I can give them specifics and the why.

Thanks!
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  #114  
Old 05-04-2010, 02:48 PM
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Default Re: Jessie, Min schnauzer just dx-ed

Hi Kim,
Lack of duration would be when the insulin doesn't last quite 12 hours. Food can have an effect on duration of insulin. So if a snack is added and the blood sugar goes up earlier and further than before, it may be that duration was the issue and the snack is shortening the duration even further.

But if we think the blood sugar is going lower than 108 at 1:45pm, a snack should prevent the low and possible rebound situation. So, hopefully you wouldn't see the higher number in the 400s because the counter regulatory hormones wouldn't kick in from blood sugar that had gotten too low.

I hope that explanation made sense.

Natalie suggested a snack at noon. I'm not sure what she was thinking as far as what type of snack. When Ali was on kibble and had a dip in the afternoon I used a regular size bone, like what a milk bone would be to prevent her low.

Patty
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  #115  
Old 05-04-2010, 04:38 PM
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Default Re: Jessie, Min schnauzer just dx-ed

This insulin lasts "about" 12 hours, which is why we give it twice a day. But like all meds, it's never exactly twelve hours and it varies from dog to dog. Our dog got only 8-9 hours out of NPH - so for him it had a short duration. Once it was gone, his blood sugar would start climbing.

The goal of the snack is to raise her blood sugar between noon and 5pm to get rid of any low blood sugar that might be causing a rebound.

You would just have to guestimate how much of a snack to give... start small. Maybe 1/4 of the size of her meal or less. As Patty mentioned, sometimes just the size of a single biscuit can be enough. I would be really conservative at first.

Are they doing any monitoring at home? Any urine testing?

Natalie
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