DKA + diabetes : Helping my mom with her newly diagnosed pug

[kimouette2]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

oh god I just remembered that Fille is still taking Simplicef until Saturday or Sunday (not sure the exact day I'll have to ask my mom). So here we have another influential factor that might give us a "false curve" this weekend

Amy you are not missing any full curves. All we have is on that spreadsheet.

Do you guys continue to test after the 2nd or 3rd hour after her meal/shot? I feel like the nadir is later than that

What makes you think that?
If you look at the couple of days where my mom managed to test after Fille's nadir (at +2 which means 2 hours after the injection ), all the collected data tells us that not much happens after +2 and that in most cases at +4 she is back to her preshot (fasting) number or even worse than her preshot number (except on 8/9, but the next preshot was as ugly as her AMPS)!

My thought of solving this dilemma is to keep her on a steady diet, whether that is adding the extra carby food or not, for a period of five days. Select the dose amount you can be comfortable with for the same length of time. Then, after 5-7 days(the weekend), do a full 12 hour curve, testing every two hours. Those numbers will hopefully shed light on what she needs. I understand not being able to do the curve during the week but the weekends are perfect for evaluating what has transpired during the week and tweaking the dose very slightly or whatever change the numbers show.

That is exactly what we are gonna do!

Obviously, if she is going lower than 100 at fasting any time during the week, then drop the dose for safety.

Is that really what you consider to be a safe way to deal with a low preshot number? I mean if she is 100 in the morning and my mom leaves for the day, shouldn't we be worried that the nadir is gonna be too low? I can already imagine my mom's reaction... she'll want to leave a bowl of honey on the floor to make sure Fille doesnt have a hypo during her absence! I know we should not base the dose entirely on the preshot number, but giving a full injection when we have a preshot of 100 makes me wonder what nadir she will have !

[amydunn19]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

The only reason I question the nadir is because the insulin should be lasting longer than two hours and there is not much information on the tests you have posted. Now, we learned a long time ago that dog's reactions don't always go by the book but I think you need more information before establishing that is the nadir. That is just my opinion on what I have seen from the numbers we have.

As I have said, set the dose at a level you and Mom are comfortable with. The thing is you have to make decisions based on what you have in front of you. The curves you will do will guide you on her reactions. Until you get more detailed numbers about what is happening with her throughout the day, you can't assume the worst. Come up with a fasting number you are comfortable with for now and reduce if fasting is below that number. So far, fasting has been high most of the time it seems. Once you guys do some curves and tweak the insulin or food then when you have lower fasting numbers, you will trust what her reaction will be. Now, it seems the fear of the unknown is holding you guys back.

My suggestions are my opinion, nothing more and nothing less. In the end, you have to do what you think is right. As I said, I know it is difficult with the limited time you have.

[Riliey and Mo]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

i think for Now your best approach would be to keep every the same for 7 days, food same kind, amount, insulin, amount, exercise etc, do a curve when your mom has the time say on the weekend. give it to your vet and post it here. the key to regulation is to keep it simple everything the same. k

[kimouette2]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

Even though between July 25th and July 31st Fille seemed to have early nadirs, it seems like her nadir is now closer to +4. That's what the curve from Saturday and the tests from yesterday tend to prove.

We were so glad to see how "almost regular" her numbers were on Saturday (even though they became ugly in the evening). These evening numbers that are above 500 are pretty scary but we will stick to 2.7U for this week unless something really unusual happens.

We will do another curve next Saturday and might increase the dose to 3.0 U if needed next weekend

[kimouette2]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

Please look at Fille's spreadsheet (the link in my signature) and tell me when you guys think Fille has her nadir! It sounds like it's changing all the time

[jesse girl]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

i dont see anything that points to a specific nadir and thats not all that unusual

my jesse is not that consistent and for me thats not a problem as long as her range is adequate and i understand how blood sugar reacts at those levels

[kimouette2]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

Geez!
I'm sure you are now completely used to the fact that your dog is not consistent, but for my mom and I this is a first case... And it is scary!

We just gave Fille her regular dose of insulin after having the lowest fastening number we've ever seen! Normally I would have asked my mom to lower the dose, but instead, I looked at the last couple of days and noticed that her nadirs seem to be very late in her cycle (compared to what is was couple of days ago when it was only 2 hours after the injection!), so based on this observation I asked my mom to maintain the dose and now I pray to god I did the right thing!
I did ask her to give her dog a little piece of chicken before going to sleep though... you know.. just to give us a little extra chance that things are gonna go smoothly

If the fastening numbers are now becoming nadirs, it's just weird. Weird and stressful for both my mom and I.

[jesse girl]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

actually to have a nadir at fasting may have its good points because most people are home at that time they are awake not sleeping so there is an advantage

jess is consistently inconsistent for her its all about fasting and the direction her numbers usually go for the day if her fasting was consistent her pattern would be the same and sometimes it is . not scary do we worry i think we all do thats normal

actually low blood sugar events are rare you dont here much about it on the forum with those who home test or monitor quite closely using other methods

if the dose is not way to much and not tons of exercise during active insulin or othe medical issues that can affect blood sugar most dogs can accept a dose and deal with it.we have seen some dogs that were heavily overdosed and still did not go hypo . now we dont want to be complacent because of this . i am one that does not believe in cruise control

when i gave a dose of insulin at a lower fasting jesse usually rises. it took sometime for me to accept that but i do have a bit of safety built in where i split her dose by giving half her dose at mealtime and the other 2 hours later

if your not comfortable reducing the dose or waiting is perfectly fine . it took me a long time to give a dose of insulin at a number like a 100

[kimouette2]

Wondering about Prozinc...

Hi again!

My mother and I are starting to think that Fille probably needs a longer acting insulin. Her fastening numbers are pretty ugly. And when she gets late nadirs she also spends many hours with SUPER ugly numbers.
(see Fille's numbers, the link is in my signature)

I dont know about long term use of Prozinc, but from what I've read, this is probably our best option if we want an insulin that will last longer.

Any of you guys have been using Prozinc successfully for a long period of time and would recommend it?

[jesse girl]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

haven't heard of any real success with prozinc in dogs i dont believe there is any active members using it at this time

i really dont buy into the notion that insulin doesn't last i use to think that with jesse i though she only got 6 hours well come to find out with some creative testing she gets about 18 hours

i think insulin can be overwhelmed by food or the body's stored sugar or antibodies from the body may attack it eliminating it from the equation

many times it can be a food component which can be difficult to figure a dose being to much causing instability or maybe a reaction to insulin itself. of coarse maybe not enough insulin

never hurts to try something new if struggling

[Joan]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

I agree with Jessegirl, this does not seem like a duration problem.

Are you still using the caninsulin? I can't find in the thread if you ever changed insulin? But the caninsuliin (vetsulin) has 2 components, one is longer acting than the other, theoretically the faster acting keeps the spike after the meal down, and the other component gives the 12 hr (hopefully) duration. In some dogs, you will actually see 2 nadirs in the 12 hr curve because of this. While this insulin works well for many dogs, for others it is impossible to regulate.

I think I mentioned to you a while ago, my previous pug started on caninsulin, but no matter what I fed, and no matter how much or little I gave her, she never ever got decent numbers. As soon as I switched her to Novoln N/Humulin N the whole universe changed for her. She was never an easy diabetic, but I got her numbers in a good range and she lived several yrs very happy and content with good weight, till she succumbed to hepatitis at 13 yrs old.

The other thing, I am not sure what percentage of protein:fat:carbs you are feeding? I looked up the raw, but not sure I am looking at the right diet or the correct Fromm? One thing that sometimes does not make sense, but many of us find though experience, is that if you do not feed an adequate amt of carbs, the insulin (any kind) will not give you the duration. You can try this by just adding a few tbsps of cooked white rice, about 15calories/tbsp, and subtracting the same number of calories of whichever food you are feeding that has the highest protein/fat.

This is doubly true when using an R insulin and/or caninsulin. It will generally work way too fast without adequate carbs, and the body defends itself by producing glucose. You may or may not find this in the bgs, I did not find it till I tested every 15 minutes for the first 6 hrs with the caninsulin. In a non diabetic dog (or person) the bg regulation is an ongoing process, in that the pancreas and liver etc work together minute by minute to keep the bgs in a normal range. When you have a diabetic only half this process is working. So the only response the body has is to keep it safe, as in not too low, but the insulin production side of the equation is absent. We compensate for this by an insulin shot. But giving this every 12 hrs, means we MUST balance the food out correctly to match the insulin.

Sorry this is so long, but I am concerned for Fille, I have a special affinity for pugs!

[kimouette2]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

Hi Joan,

I've been asking about Humulin N Vs Caninsulin here on this forum but the responses I got were that these 2 insulins are the same and the only reason why most people switch to Humulin N is because of the price. So yeah I did think about switching to Humulin N, but I have to admit that I was looking for an insulin that would last longer, and I hate that it is a U100 insulin!
At only 3.25U per injection, it is already complicated to measure the dose consistently. SWitchting to a U100 would'nt make it easier that's for sure! But if some of you guys think it will probably make Fille more stable than Caninsulin, then it's a different story!

Fille is fed with 2/3rd of raw food + 1/3rd of Fromm shredded chicken:
http://frommfamily.com/products/four...redded-chicken

So yeah we have increased her carb intake since the cans she eats contain vegetables and starch.
This might have helped in terms of "drastic roller coaster effect" of the insulin (between fasting and nadir), but it has increased her need for insulin and still doesn't get rid of the super high fasting numbers.

My mom is willing to try many different things here (insulins, food, tests ect...) but one thing you cannot ask her to do, is to feed her dog with grains. She has had many bad experiences in the past where feeding her dogs with grain-free food suddenly got rid of their diseases.
I simply know she wont EVER accept to give fille some rice or any other grain. Actually, when I spoke to her about adding some carbs to Fille's meal, she was already pissed at me cuz she knew that it would increase her need for insulin. She felt it was like giving a chocolat bar to a diabetic kid and ask him to double his next insulin shot!
So if giving Fille rice or any grain or sugar means we are litterally making her pancreas sicker (even though it would serve another purpose like making her more stable through higher blood glucose values) she wont do it, and I cant blame her for that.

[stylynjm]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

how about potatoes, white or sweet if you need a carb

[Joan]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

Yes potatoes work well on most dogs.

Actually adding more carbs, substituting them for some of the protein and/or fat, does not usually take more insulin. I find that the amt of insulin is pretty much determined by the number of calories. The shape of the curve, including the difference with the high point and the low point is determined by the composition of the food itself.

Now again, every dog will vary somewhat, but both of my diabetic pugs have needed a fair amt (up to 50%) carbs to get good, even, repeatable glucose readings throughout the day.

My current pug is 20 lbs, total insulin per day is 6 units. I have tried him on higher protein diets, and his numbers are awful, and it affects the pancreatitis as well. Carbs for the most part do not stimulate the pancreas to produce enzymes for digestion. Thus much easier and therefore more comfortable. Every diabetic dog obviously already has a problem with their pancreas...so the easier we can make for it to work, the better/safer we are. The insulin producing part of the pancreas is already toast so to speak, so carbs are not going to harm it further.

Equating how a dog with type 1 diabetes reacts to insulin, is totally unrelated to how a human (kid or otherwise) with type 2 reacts.

If your mum will read some articles on this to get a better understanding of how and why dogs react to insulin, diet etc. I can send you some links on the subject.

BTW the discussion on insulin types is usually comparing Humulin N to Novolin N, Caninsulin (Vetsulin in USA) is a completely different insulin, both in composition and reaction.

[amydunn19]

Re: DKA + diabetes : Helping my mom with her newly diagnosed pug

The thing is that it doesn't matter if balancing her food requires more insulin. Requiring more insulin is not a bad thing nor does it symbolize that there is something wrong with the diet or the caretaker or the dog - the dog just requires more to keep numbers stable.

I understand on one hand - we all have different experiences that bring us to a different place but if her blood sugar is not under control and the goal is getting her regulated, then it may be time to look at all the options. With my perspective, I would feed cardboard if that kept her alive and thriving. Luckily, it didn't come to that. It is kind of like not seeing the forest for the trees. If she is not doing well, there is little consolation that she is fed a premium diet.

There are a few people who feed grain free kibble - the trick is to not have such high levels of protein and fat. I feed grain free and potato free because Maggie cannot tolerate potatoes or rice. The carb source is chickpeas.