New member looking for advice

[Bellandanny]

Re: New member looking for advice

Hi everyone, just had a couple more questions that you may be able to answer. Bella had her eye doctor visit, and sadly she has glaucoma in one eye and mature cataract in the other. We likely won't do surgery, especially if we can't get her diabetes stabilized. We'll do another curve tomorrow and I'll post here.

One thing I've noticed, and pretty sure it's consistent, is that her blood glucose curves go way up every time we open a new vial of Vetsulin. And her curves are best when drawing up the last bit towards the end of a vial. Also for example, yesterday after injecting the last of the old vial she was playful, and drank way less water all day. Today with the injection from a new vial she has refused to move all day and has drank literally 4x as much water as yesterday!

Any idea why this could be? The instructions say to shake until it's milky, and to let any foam on top subside. However I've noticed that with new bottles especially the foam doesn't subside for days. Could this have something to do with effectiveness? Also, should we be injecting air (the same amount to be withdrawn) into the vial every time?

Anything else you can think of that could cause vial to vial inconsistency? Should we consider switching insulin, and if so which one would be the closest to Vetsulin?

Thanks!

[jesse girl]

Re: New member looking for advice

Have had a similar experience with better sugar with an older vial compared to new . Some have said the opposite . My theory is the insulin may become more potent as there becomes less in the vial . Maybe the mixing isn't up to par and maybe more diluted in the beginning . Make sure your mixing properly .

Now another thought it takes time for a new vial to settle in . Kind of like giving a new amount of insulin where it takes a bit of time for the body to adapt and settle into a new dose . It maybe the same for a new vial of insulin . Usually for my Jesse after about a week her numbers would settle back down to where they were previously after using a new vial of insulin So I would hold onto a vial as long as I could to keep the numbers consistent . I could keep a vial up to 3 months

The eye problems are a bummer and some of the complications that K9 diabetics may experience

I am not one to wait on important medical procedures just because blood sugar regulation isnt that great . I dont think it play that much of a factor and the medical condition a dog maybe experiencing maybe causing the problem with getting better regulation . My Jesse had surgery with very high blood sugar and she healed up fine but that was my experiance

Hope you can figure out the eye problems and with that you maybe be able to improve blood sugar

[Riliey and Mo]

Re: New member looking for advice

Hi
Priority to treat the eyes. Was she given eyedrops?

Switch insulin to novolin nph. Drop back one whole unit as its more concentrated.
You wont have the vetinsulin problem. Have strips on hand to test, test, test. For the drop in blood sugar.

[Bellandanny]

Re: New member looking for advice

Here's Bella's latest curve, on 17 units Vetsulin:

08:00am: no test (before meal and shot)
10:00am: High (over 600)
12:00pm: High (over 600)
02:00pm: 529
03:00pm: 489
04:00pm: 470
06:00pm: 372
08:00pm: 472 (before meal and shot)
10:00pm: 344
11:00pm: 313
11:30pm: 472

I decided to do some extra testing in the evening, and hmm, what could be going on here? The meals at 8am and 8pm were identical. We went on a longish (1.5 mile) hike at 7:00pm, maybe that affected the lower evening numbers? Glad to see the lower numbers, but more confused than ever now.

[Bellandanny]

Re: New member looking for advice

And I figured I'd do some more testing around meal time this morning to see how it compared to those lower numbers last night:

06:30am: 442 (upon waking up)
08:30am: 378 (right after meal and shot)
09:15am: 481
10:00am: High
11:00am: High

Again, same exact meal, insulin vial, shot location, no treats, etc. So basically, 12 hours ago she was at 313 (almost her lowest reading ever) and 12 hours later at shes over 600.

If anyone has any insights it's much appreciated!

[Riliey and Mo]

Re: New member looking for advice

Theres evidence half hour after food the blood sugar goes up meaning theres too much food.
The insulin an hour and half after injection isnt meeting up with the food as it reads hi.
Double check after high readings.

A walk around 10 am will bring the bg down

Any other eyedrops than prednisone?

What meter are using?
Where are u injecting?

[jesse girl]

Re: New member looking for advice

Early in my Jesse's diagnosis I took her to the vet to do a curve and asked them to compare my meter to their lab analyzer( the most accurate way to test blood sugar ) I was using a human meter at the time . At her highest level in the low 500s on my meter the lab registered in the mid 350s . As the numbers drifted lower and in the 100s the 2 forms of testing the numbers became closer together and almost identical in the low 100s . Yes jesse's blood sugar could go from 500s to 100s in just a few hours but in reality according to the lab analyzer she wasn't as high as what my human meter was saying . Still high but not near as high as I thought.

I feel if a dog is very high above 500 on a hand held meter you would think a dog would be in crisis . Also like your dog you would think there is enough insulin in the system to keep her below 500

So at these levels on a handheld meter you maybe getting a skewed pattern and it maybe difficult to draw any conclusions

Now the only way to know if the numbers are fairly accurate at these levels is compare to a lab analyzer and hopefully like I did with jesse we got to test at a wide range of levels from low to high . At least in my situation treating Jesse's diabetes I did not place much emphasis at high level patterns and try to make sense of it on my meter . Now this is just my thoughts on my jesse's situation . I cant judge what is going on with other dogs and only can offer an opinion from what I have seen in Jesse's situation

So it possible your dog could be in the 300s to 400s for large part of the day . Still high but not in crisis . I have seen dogs not do any better than this and did ok without any medical difficulties except for the cataracts . The things with dogs there life spans are not that long to begin with so they really don't succumb to the ravages of higher sugar. My jesse is a rare example of living quite long with the disease and her sugar has been far from perfect during periods of her diabetic life and she has lived a happy dogs life

Like I suggested the eye problems and medication can affect insulin resistance which may require a higher dose of insulin . The thing about blood sugar we dont know where and how its being produced when we test blood sugar . You can get it from digestion and or the body storage capacity . Also the body has way to make insulin not as effective ( insulin resistance ). My personal thought I believe dogs dont really produce big food spikes . I think spikes in sugar are more hormonal and a response to something within

In my opinion your not seeing big swings in sugar like my jesse had so hopefully you can get to better level ( 200s to 300s) that could be good enough for regulation but like i suggested you could get up to 25 units but without improvement at that level you may have to rethink your approach and try something different thinking outside the box .

[Bellandanny]

Re: New member looking for advice

Thank you both!

Yes, I was wondering if she's getting too much food. The vet keeps saying to feed her more, because she's lost some weight since this all began, but I think that may be mostly from muscle loss, to be expected with less strenuous activity recently. She's currently up to about 1200 calories per day, which seems like a lot for a 38lb dog who's now pretty inactive. That said, she's not gaining any weight with that much food either. It's a mix of Ketona dry food (high protein/low carb), Purina One grain free pate (mostly just turkey and ground venison) and Rachel Ray wet (lamb with some vegetables). We've settled on this because she gobbles it up, whereas before it was a challenge to get her to eat consistently, so I'm wary of changing it up.

Eye drops are pred sulfate and an NSAID in the good eye (to keep lens induced uveitis at bay), and an antibiotic ointment for the glaucoma eye which has a little ulcer. She's also on 75mg/day of Carprofen NSAID.

The test unit is called Test Buddy. I have wondered how accurate it is, as I tested my own blood haha, and it read higher than I know I am, but I'm not sure it that means much. Should I consider getting a new test unit?

We've done 2 lab blood glucose tests so far, and they both came back similar to the meter, maybe a little lower, around 450 a couple hours after meals. Also a fructosamine test that just said she was poorly regulated.

Injecting around the hip area.

Her eyes seem to be improving a bit, but the one with glaucoma still looks pretty bad. It didn't test too high for pressure tho, 9 vs 7 in the other eye, and the eye doctor mentioned something that may have occurred that's basically "nature doing it's own glaucoma surgery", but didn't really elaborate. She did say for now Bella likely isn't in pain, or in any immediate concern for worsening. My guess is we'll end up removing the bad eye, and treating the other one with meds.

Lastly, we have an appointment for an ultrasound and consult with an internist this week. Hoping this sheds some light on things.

In the mean time, it's good to hear that going up from 17 units is a reasonable plan. The vet keeps mentioning she's reaching the upper limit, but I've read varying numbers as far as what that is as far as units/body weight. Perhaps the internist will have more info about that.

Thanks again!!

[Riliey and Mo]

Re: New member looking for advice

38 lb dog calorie is about 538 calories. Check out a food calculator
Holly 1200 calories
So yesss too much food
Mixing 3 types of food is hard to calculate
Dogs gain weight only when their close to regulation. Bad vet advice!

Consider buying the dog meter you xan get it on amazon forcabout $70.
This test buddy isnt reading low or high numbers accurately. At this point you need an accurate meter.

Alphatrack.

Inject mid back top of the leg. Its close to a blood supply. Tent then inject
Dont inject in the hip.

Have you considered checking out a new vet?

Honestly i would not raise her insulin until you get the accurate abbott alphatrack blood sugar meter for diabetic dogs. Both you and your vet are guessing what you need to do and chasing numbers.

Curves are showing you the problems are with the meter and amount of food and injection site

[Bellandanny]

Re: New member looking for advice

Thanks, good point about weight gain and regulation!

And yeah, I think it may be worth it to try a new meter at this point. Is this the one? https://www.amazon.com/AlphaTRAK-Blo...s%2C247&sr=8-4

Mid back top of leg is where we've being going, not so much the hip now that I think of it.

And agreed on the vet. She's a good local vet, and has had the best availability amongst some very busy vets lately. We'll be seeing a highly regarded internist this week, so perhaps they'll be more knowledgeable.

[Riliey and Mo]

Re: New member looking for advice

Yes thats it. Its made by abbott. Turn off the meter sound in settings. Use lancets without the device
Freestyle lite strips work with alphatrack their cheaper

Mention the 3 foods and amount to your new vet
Progress today eh!
Thankyou

Just got my moderna vacc. Its very strong.

[jesse girl]

Re: New member looking for advice

I have used the inner lip for the last 11 years with great success No discomfort for her and she would give me a kiss after on occasion Silly girl . I dont test her very much at her extended age now but once in a while I will give her a poke but mostly I just watch how she is doing . So much different from her early days of testing her maybe 10 times a day . For most of her diabetic life after she became regulated ( in my opinion as regulation can be different depending on the dog ) I mostly just tested her before each shot as once you give it you cant take it back so I wanted to know what blood sugar was before if I needed to make an adjustment depending on blood sugar level . 99% of the time there was no adjustment needed but early on i may need to give her a sugar boost as she could drop quite a bit after shot . Now she is on such a lower dose and she gets 3 of them the odds of her going low is quite slim so I don't worry like I did back in the good old days haha .

You have a good attitude and your looking for answers to improve your dogs regulation . Most people who want to put the work into it will have success at getting their dog adequately regulated where diabetes is not a problem anymore

[Bellandanny]

Re: New member looking for advice

Hi all, just another update. No new curves yet, but Bella had an ultrasound and internist consultation today. It seems she has some unknown lump in there that's likely causing the diabetes and/or affecting regulation. The internist said it's likely either a cyst affecting the pancreas and therefore messing with insulin production, or a tumor from a leftover ovary piece messing with hormones. He said a CAT scan may be more definitive, and necessary to consider surgery. He also said in his opinion it's more likely a cyst which could be fairly easily drained, but could cause complications if that's not what it is and/or causes bleeding.

After talking it over, it seems the best plan may be to continue as we have been addressing the diabetes, as long as she's not having high numbers all the time, and not losing weight. He suggested we do another ultrasound in a few weeks and/or if she begins to have further issues, and at that point attempting to drain the cyst might be a good idea.

As I told him, Bella is seemingly doing better the past week or so. She's for sure drinking less, has good energy, and is eating great. I've done a few bg checks in the afternoon and they've been in the high 300's. She weighed in today at 37.6lbs, so doesn't seem to be losing weight, and I've actually been feeding her a little less as was suggested here (800 calories/day vs 1200 before). I mentioned that she had a couple weeks where she seemed to regress with higher numbers and more water drinking, and he said that could likely be due to the eye infection/inflammation.

Her right eye is looking better, still red but reduced in size, and the left eye looks almost back to normal. She has a follow up with the ophthalmologist next week.

Would love to hear what you think, you've been very helpful so far, and while this new info may throw a wrench into it all in a way, it also sounds like confirmation that treating the diabetes is the best course of action, and that in doing so we're making progress in Bella's overall health.

Thanks as always!

[jesse girl]

Re: New member looking for advice

I dont think a tumor on the pancreas would affect regulation because dogs in most cases are type one diabetics and don't naturally produce insulin in general and completely dependent on injected insulin Now maybe the general consensus is wrong and many dogs still produce some natural insulin and why some dogs have lower doses than others. It's all an educated guess . Hormones can produce insulin resistance with an intact female in heat but a spayed female if still had an ovary and still cycling you would see more ups and down patterns .

Now the eye problems can affect regulation and cause some resistance as pain can release hormones like cortisol . Now once that is resolved there maybe less insulin needed . So since your dog is feeling better it maybe a good idea to hold at the current dose . May want to take a break from curves for now and just keep spot checking to make sure a low pattern doesnt show up with healing eyes . Once the eyes are healed you can get back to regulating blood sugar .

Hope things continue to improve for your pup . It seems like you 2 are settling in for the long haul

[Riliey and Mo]

Re: New member looking for advice

Good report

400 less calories and you in the 300,s
Amount of food is important as is the amount of insulin.

Fyi
If she ever feels unwell and doesnt eat her food its recommended injectioning 1/4 of the dose. Because bella is on a high dose, i would consider giving 1/4 of the starting dose for 38 lbs.