Sweet Dutch has passed December 6, 2015

[jesse girl]

Re: Diabetes/Leg Problems/Sores

novolin seems to have stronger action in jesse did you reduce the dose when you made the change i do get concerned if the dose becomes much larger than what was on humilun and if you started with the same amount as humilun it may have been a tad to much and increasing the dose may have exasperated the situation

my jesse it appears her body know when it is to much insulin if i give her 2 units she may spike after shot by a 100 points if i give her 3 units she may go up 200 points quite interesting no drops or anything which doesn't show evidence of rebounding just the higher dose with a higher spike

i know it is dificult to lower the dose to higher numbers and its possible you may have to lower the dose below what he was on with humilun what you would like to see is the higher number come down it still might be elevated this is why it can be very difficult to establish overdosing i deal with that with jesse to this day

of coarse it could be a coincidence and the higher numbers maybe do to other medical issues

so this is where you put on your detective cap and do a bit more testing to figure things out

[Timothy]

Re: Diabetes/Leg Problems/Sores

I haven't measured a full curve. But his sugar has been consistantly in the 400's throughout the day. How can I tell if hes being overdosed? He was on 26.5 units of Humalin and now hes on 32 units of Novolin. Ive been away for school so my family has been watching Dutch for the last few months. Also The sclera part of his eye is spreading over his cornea. His

[Rubytuesday]

Re: Diabetes/Leg Problems/Sores

hey there, without having done a full curve there is no way to be sure he isn't dropping too low and then spiking back up and that is the highs you are seeing.

I suspect since the increase didn't help bring the numbers down that he is probably getting too much insulin. 4 units should have made a difference if he just needed more insulin and you said he showed no improvement.

Hope you can do a curve and post the numbers so we can help you figure it out.

Tara

[Timothy]

Re: Diabetes/Leg Problems/Sores

Here is Dutch's curve for today. I started to do it yesterday but got caught up in other things outside but I'll post that too.

Edit:
His curve didn't make much sense to me earlier today so I went ahead and kept testing him and his sugar dropped in the evening. I wasn't sure so I gave him a snack and it immediately went up within a half an hour.

[momofdecker]

Re: Diabetes/Leg Problems/Sores

Timothy,
I'm not great at reading curves but wanted to compliment you on taking such good care of your boy! Love the pictures of him in your album. Looks like he does get a good drop between 12:30 and 2:30p. Glad you continued to test into the evening. I'd probably have given a snack too - just to be on the safe side. I'm sure others will be along that can provide more sound advice on the curve itself.

[jesse girl]

Re: Diabetes/Leg Problems/Sores

i am with hollie you are seeing some bouncing around and a substantial drop

are you sill using nph

we have seen levemir has worked well for larger breeds with eratic blood sugar on nph with a more level profile

with that being said it is possible to try going with multiple meals during the day less food at the beginning during the rise and more at the end to combat the drop this does take some work to figure

it appears you can not raise the dose anymore from what this curve looks like

if you do decide to try levimer remember it is 4 times more potent than nph and i would go lower than that for a starting dose just to reset things

if you decide to split meals take it slow in transition to look for positive results and how to proceed

[Rubytuesday]

Re: Diabetes/Leg Problems/Sores

" We switched to Novolin N a while back and I don't know if it is working. His sugar is constantly high. Around thanksgiving he started loosing more weight. I increased his dosage from about 26 to 30 now and its still close to 500."

Hi Timothy, Just so I get the whole picture, can you tell me on this curve when Ducth was fed and given his shot am and pm. Was he exercised during the day?

My fear is that Dutch could be in a vicious cycle of rebound that has been going on since Thanksgiving. I have no idea if that is even possible for a dog to handle having too much insulin for that long, but let me tell you why I am afraid of this.

I looked backed and saw that at one point 28 units was too much for Dutch and he was having lows with that dose. I assume that was when you backed off to the 26. Then the switch to Novolin and you probably increased when you saw some high readings, but I think maybe you should have reduced. The Novolin could be stronger in Dutch then the NPH was and the initial highs, like these are not highs from too little insulin, but highs from too much insulin.

When the numbers go too low the liver panics and shoots out stored glucose jacking the numbers back up.

I would cut him back to 25 units and not do another curve until 5 days to allow his system to calm down. Then if he wasn't having any big drops you could work your way back up in 1/2 unit increments, but you might even have to cut the dose more.

I know in the past there has been talk about giving Dutch a snack to boost the midday numbers, but I would want to find a baseline dose that doesn't drop him too low without intervening with snacks. Then I would progress slowly with adding a snack while increasing the dose ever so slowly.

Can you give us a sense of what goes on when you are away at school? Is there someone else that can test him? If not how long before you go back to school? You must worry about him terribly while you're gone.

Tara

It was a very good intuitive move on your part to continue the testing. So glad you caught that second drop.

Tara

[Timothy]

Re: Diabetes/Leg Problems/Sores

Timothy,
I'm not great at reading curves but wanted to compliment you on...

Thanks for the encouragement.

Are you still using nph...we have seen levemir has worked well for larger breeds with erratic blood sugar on nph with a more level profile...it is 4 times more potent than nph...

He is on Novolin N right now. That's good to know, Mabey I'll look into that if I can't get the Novolin N straightened out. Even the Humalin N was hard to get regulated.

Just so I get the whole picture, can you tell me on this curve when Dutch was fed and given his shot am and pm. Was he exercised during the day?..Dutch could be in a vicious cycle of rebound...I assume that was when you backed off to the 26. Then the switch to Novolin and you probably increased when you saw some high readings...

He Eats at 6:30 and gets his shot at 7:00, both AM/PM. If I notice his sugar is high sometimes I give him his food closer to the time of insulin shot, and if it's lower then I give it at 6:30. The only exercise he has been getting for a while is his regular bathroom breaks, I have not been doing any tough exercising like earlier this year. That's what I'm worried about too the overdosing. Yes that's pretty much what happened, He switched to Novolin N and then problems.

Can you give us a sense of what goes on when you are away at school?

I say "I" a lot but that's just to simplify things. It's more of a team effort between Me and the rest of the family. They do a good job. I do all the testing and regulating and exercise though. I got some test strips for thanksgiving to start to try and regulate him but I ran out of time. Just got a 50 pack of strips. I start school again at the end of January so I want to get it figured out before then.

[Rubytuesday]

Re: Diabetes/Leg Problems/Sores

Thanks for all the info Tomothy.

So what is your plan? Will you do a reduction?

Tara

[Timothy]

Re: Diabetes/Leg Problems/Sores

He got 25 units this morning. When he was getting overdosed on the Humalin he was having really small seizures. Wouldn't he of had a seizure if he was being overdosed on the Novolin?

I am going to try to get him a vet appointment though this month to get his eyes checked out. I think he might have some kind of eye infection or something. I've been keeping them clean with a warm washcloth. But if it is an infection then I'm sure they can give me something for it.

[Rubytuesday]

Re: Diabetes/Leg Problems/Sores

The way I understand it is there are degrees of overdosing. I think what you may be seeing now is this:

http://diabetesindogs.wikia.com/wiki/Somogyi_rebound

This link has some good visuals on the bounce that will occur when the liver panics and releases stored glucose to "save" the body. There is also a pink box at the bottom that explains why it is important to give the body time to reset itself after reducing the dose.

I think the siezures were probably the more extreme reaction to being overdosed in which the liver had tried to release stored glucose but it wasn't able to overcome the insulin.

When fine tuning a dog you learn to look for subtle signals and one of those is that if you increase a dose and instead of seeing lower numbers you see higher or the same then overdosing is suspected.

Unfortunately without curves prior to previous increases this is only guess work. That is why you want to do a curve prior to each increase. Just seeing one high at a fasting doesn't tell you if it is a high in response to a low earlier. Lows are true lows where as highs may be false highs due to the liver panicking and shooting out glucose. Whereas if the liver didn't panic the numbers wouldn't be as high, creating a "false high". Therefore you want to dose the insulin according to the low. Sometimes folks have even reduced when they see higher fastings only to see things even out a bit more as raising the lowest number may prevent the liver from panicking. Going forward it will be important to have a curve prior to each increase as then you won't need to guess.

Now in regards to the eye, Ruby used to get a goopy eye and she did have an ulcer. With her it was the first indication that she wasn't seeing well. We treated the ulcer and she would still periodically have a discharge. We would try antibiotics ect. and never had great luck with them. I have a theory that her constitution was just weak. What finally helped her was a product called Eyes So Bright. Here is a link:

http://www.onlynaturalpet.com/produc...ht/121020.aspx

Now if he hurt his eye or has an infection in it that could be raising his numbers and requiring more insulin, but I hope you can hang with the decrease as then you won't have to be guessing.

If you post curve results as you take them folks can help you come up with an ideal increase amount. I know it can be hard to be patient when seeing high numbers, but I think Dutch may be one of those dog's that you might overshoot by going a 1/4 unit too much.

An aside, if you haven't heard this before is sometimes the markings on the syringes can be off. Before drawing up the insulin I push the plunger in to be sure the bottom of the plunger sits at the bottom of the zero mark. Sometimes the can be off as much as a 1/2 unit.

Hang in there.

Tara

[k9diabetes]

Re: Diabetes/Leg Problems/Sores

I think it's hard to say much about what to do with his blood sugar until the eye and, if stil going on, sores on his feet are resolved. Any inflammation and infection can raise blood sugar and/or make it erratic.

I would reduce his night time dose based on the low blood sugar that you caught. Could be that's been happening often.

But since he was fairly stable this summer and fall and now has infections and sores, much of what's happening with his blood sugar could be solely related to those problems.

Natalie

[Timothy]

Re: Diabetes/Leg Problems/Sores

Well actually the sores on his legs have been an ongoing problem for a while now. Probably since the beginning of 2012, most of them small. But they do heal. When he was a much younger dog, he used to get "hotspots' on his feet very frequently and would neurotically lick his legs all through the night.

When he had a bladder infection earlier in 2012, he was put on an anti-biotic which helped him a lot. When he went to the vet last his sores had healed so I never made a fuss about it at. But about a month or two after he got off the anti-biotic he had another flare up of open sores/ulcers that were really bad. And they have been chronic since then. Even during the summer when we got him regulated. I was worried he would loose a leg they were so bad. The only thing I could do was keep them clean and keep an eye on them.

Right now the old sores have healed over into big callouses but he does have a couple small open sores that are not too bad.

About his eye problem, I'm pretty sure it's an inflammation problem. It looks like it is just in 1 eye. His corneas sometimes look like they are beginning to develop cataracts, and start getting really cloudy. BUT with some TLC the corneas do clear up.

Right now his right eye does look a little inflamed, I said earlier that it looked like the sclera was covering part of his eye, BUT after looking at it closely a few more times, I think it might just be the conjunctiva that is swelled up not the sclera. His corneas are actually pretty clear except for a spot or two of cloudiness. He can see, just not as well as he used too.

His constant weight loss, I will have to figure that out after I get him back on track. He did not gain noticeably any weight when he was regulated over the summer.

Here is something that I never mentioned on this forum, He has had ear problems for a really long time now. A couple years ago before he was diagnosed with diabetes, his ears would get really nasty with black goop. We talked to the vet about it before and they said it was ear mites or allergy related. Before his diagnosis of diabetes he started developing polyps in his ears. This made his ear condition worse, harder to keep clean, and causes some discomfort for him now and then when they flare up. He was treated a while back for them and the treatment helped a lot, the polyps had shrunk considerably. They go back and forth between shrinking and getting inflamed. Surgery to test for cancer and also to remove the polyps is beyond a reasonable price. I do not think that it is cancer though, I think that they are just polyps. Surgery to remove/test them is just too much. So the only thing that I can do right now is keep them really clean and try to shrink them! He doesn't mind much, he is still happy.

I did cut his insulin back to 25 units last week. His sugar stayed in the upper 400's and in the lower 500's and he was practically bedridden for a couple days. I increased him slowly over a couple days because that low of a dose just wasn't working. I did not measure a curve because I was trying to conserve on test strips but I did check him numerous times throughout the day. He has been drinking water by the gallons and we all have been taking turns taking him for walks all throughout the day and night.

I did bump his insulin up since then he is getting 28 units for the last day or two, his sugar has been close to 500 around meal time and today it was in the mid 300's about 3 o'clock. At 25 units it pretty much stayed at high numbers. I think that I might end up bringing it back up to around 30 units. Like I said, I did slowly bump it back up to 28 units, but i'm not going to increase it again until I get another couple bottles of test strips!

This is just in general, I was wondering if anyone else notices this? When the insulin starts cutting down his sugar #, the color of his urine gets considerably darker. If his sugar is high in the morning, when his levels get down to normal, his urine is darker. For example, last week when his sugar was high and he was drinking a lot of water his urine was really pale. But when it got down to 90 that night, it was much darker in color. I have noticed this for such a long time that that it is almost another way I can tell how his insulin shot is effecting him for the day by the tint of his urine...

On a good note, today I cleaned him up and we went out in the snow and played with a stick. He pranced around the yard like a deer. We had fun.

[momofdecker]

Re: Diabetes/Leg Problems/Sores

This is just in general, I was wondering if anyone else notices this? When the insulin starts cutting down his sugar #, the color of his urine gets considerably darker. If his sugar is high in the morning, when his levels get down to normal, his urine is darker. For example, last week when his sugar was high and he was drinking a lot of water his urine was really pale. But when it got down to 90 that night, it was much darker in color. I have noticed this for such a long time that that it is almost another way I can tell how his insulin shot is effecting him for the day by the tint of his urine...

On a good note, today I cleaned him up and we went out in the snow and played with a stick. He pranced around the yard like a deer. We had fun.

Got me thinking.... Just took a urine sampe to vet today because I suspected Decker had a UTI. He's been licking a lot and the color is darker than it has been. When vet called to tell me urine was fine she mentioned that concentration of it was good, especially with Decker being on prednisone and being diabetic. She'd expected it to be much more dilute. Wonder if I'd been seeing the lighter yellow color because he'd been drinking more. Drinking is more than average but reasonable now. Maybe that is why the color is darker. Gotta love snow for making things like that so obvious. Anyway, if that is the case, then yes, Decker's urine seems to be darker when he drinks less water.

So glad you were able have some fun outside!

[Rubytuesday]

Re: Diabetes/Leg Problems/Sores

Yup, I think the more he drinks the more dilute his urine will be. Likewise the better the numbers, the less he will drink and will have more concentrated urine.

If he is having the open sores now the doctor may be able to figure out what they are. Can you take a picture and post it?

In regards to the ears I would assume the nasty black goop is a separate issue from the polyps. A product I like for most ear conditions is Zymox. You can use the non steroidal one over the counter. It is an enzymatic cleaner that eats up the discharge in the ear.

In regards to whatever you are using now or in the past (can't tell from your post if he is on it now) to shrink the polyps, I would check to see if it has a steroid in it as some ear medications do and that would most probably raise his bgs.

It can be a catch 22 because some ear treatments containing steroids can reduce inflammation, but over time can also thicken the tissues of the ear canal possibly exacerbating the problem you are trying to fix.

Maybe if Zymox would help enough that the polyps wouldn't cause a problem as is.

Tara