Struggling with high fastings and short duration of effect of insulin

[joolsp]

Hi all, new poster here. Dexter is our 9 yr old mini Schnauzer, dx Sept 2017. Never regulated either on Caninsulin or Novolin - we are currently getting very high fastings (well into the 600s/30s) although for the majority of the day/night his BG comes down to an acceptable range. The duration of the insulin's effect just doesn't seem to last and we are seriously considering a longer-lasting insulin such as Levemir/Detemir. Anyone else struggling with very high fastings but otherwise ok readings for 7/8 hrs per day? Any advice much appreciated. Dexter eats Honest Kitchen Zeal, Nulo Cod and Lentil kibble and plain, boiled chicken. He is currently on 6.5u Novolin N twice a day (and we have been experimenting with Novolin 30/70 to deal with food spikes).

[jesse girl]

Re: Struggling with high fastings and short duration of effect of insulin

Hi and welcome

If you can post some recent curves . Let us know how much your dog weighs and how much insulin is being used

Big swings in sugar may point to a dose being to much . I dont fall into the camp of insulin running out . It is either overwhelmed by the bodies sugar or negated by the body in some way in my opinion

[Raysaint]

Re: Struggling with high fastings and short duration of effect of insulin

Are the high fastings in the morning, evening, or both?
Mornings as you probably know have some hormonal things working against it. I still struggle with morning fastings; they aren't crazy high , but don't stay consistent day to day. I have 3 or 4 days around 8 - 11 (145 - 195) and then 3 or 4 in a row of 13 - 16 (235 - 280).

And certainly insulin is weaker in the first and last couple hours so sugar can rise. But rising really high after good midday numbers is hard to figure.
Just remember longer acting insulins won't handle after meal spikes at all.
I don't get concerned with after meal spikes for a couple hours, as long as he starts coming down after that.

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

Both mornings and evenings. Occasionally we'll get a lower fasting in the morning (300-400s) but nowhere near the figures you mentioned below.

I could deal with the post-food spikes as well if the numbers came down and stayed down. Very frustrating.

Are the high fastings in the morning, evening, or both?
Mornings as you probably know have some hormonal things working against it. I still struggle with morning fastings; they aren't crazy high , but don't stay consistent day to day. I have 3 or 4 days around 8 - 11 (145 - 195) and then 3 or 4 in a row of 13 - 16 (235 - 280).

And certainly insulin is weaker in the first and last couple hours so sugar can rise. But rising really high after good midday numbers is hard to figure.
Just remember longer acting insulins won't handle after meal spikes at all.
I don't get concerned with after meal spikes for a couple hours, as long as he starts coming down after that.

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

I'll post some recent curves a bit later but Dexter weighs 7 kg and is on Novolin N 6.5u twice daily.

I'm familiar with the theory behind Somogyi Rebound but the curves don't fit with the classic rebound shape. We are seeing big swings though. We've tried reducing insulin but the numbers went even higher and I'm terrified of ketones and other complications.

It could just be a 'Schnauzer thing'. Judging by the number of people on other forums who experience a similar pattern with their Schnauzers (very high fastings and too short a duration of effect) it could be a classic case of rapid metabolism of insulin. The breed can be difficult to regulate.

Hi and welcome

If you can post some recent curves . Let us know how much your dog weighs and how much insulin is being used

Big swings in sugar may point to a dose being to much . I dont fall into the camp of insulin running out . It is either overwhelmed by the bodies sugar or negated by the body in some way in my opinion

[amydunn19]

Re: Struggling with high fastings and short duration of effect of insulin

Schnauzers are a challenge to regulate - schnauzer syndrome is a real thing. They have high tryglycerides typically, which can create some regulation problems. Have you had any type of thyroid testing?

Have you ever tried any kind of snack during the day to try to slow down that insulin a bit?

Without seeing a curve, it is hard to say what might help. What is the lowest blood sugar you have seen? Is is possible that the dose is not enough? Schnauzers usually require a higher dose and 6.5 units is not close to resistance just yet.

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

Hi Amy, thanks for your input.

Dexter did have very high Triglycerides but they are now under control (very low fat diet, Omega-3s and Bezafibrate). He is on Thyro-tabs and his T4 etc. is now in range.

We've tried plain chicken snacks, sardines etc. during the day. They will usually spike him no matter what we give him, or at least start the upward spike which peaks at fasting.

We have so many curves. The problem is no two curves are the same so it is really hard to know what to base any decrease/increase of insulin on. I'll post one or two at the weekend.

Lowest blood sugar is around 5 mmol/l (90 mg/dl) - pretty rare though. We home test with at least 3 pokes a day (2 fastings and a nadir).

Just reading through some of the forum posts our case looks to be similar to Cooper's here: http://k9diabetes.com/forum/showthread.php?t=5010

Cheers

Julian

Schnauzers are a challenge to regulate - schnauzer syndrome is a real thing. They have high tryglycerides typically, which can create some regulation problems. Have you had any type of thyroid testing?

Have you ever tried any kind of snack during the day to try to slow down that insulin a bit?

Without seeing a curve, it is hard to say what might help. What is the lowest blood sugar you have seen? Is is possible that the dose is not enough? Schnauzers usually require a higher dose and 6.5 units is not close to resistance just yet.

[Daisydog10]

Re: Struggling with high fastings and short duration of effect of insulin

Daisy is a mini and I found that she can only have about 19-21 grams of carbs per meal. She had fatty lumps and her triglyceride level was through the roof. She's on a very low fat diet and her lumps have absorbed and her triglyceride level is down.

Although she is on a low carb diet, she does need a little carb during the mid morning-afternoon (around 1130ish, give or take 20 min) to even her out until fasting.

I ran curves on her every half hour to see how she was digesting her food. I found that she metabolized her food very slowly and her nadir was 3 hours after she ate, then she steadily went up in the 500's on fasting. Her food wasn't keeping up with her insulin (Thank you Natalie!!!) and was being used up. I put her on a limited diet (chicken, chana dal, green beans a little kibble) so I could watch how she digested her food. I measure all ingredients in grams.

I speeded up her digestion in the mornings by soaking some kibble and making it mushy (like baby food). Her insulin and food matched much better and her nadir hit around 1145ish but then started to rise and was in the 400's by fasting. I gave her a carb around nadir time and she evened out.

Since I work, I bought an automatic dog food feeder so she can get her noodle at 1130. I actually have two feeders. One is in the kitchen and one in my bed for her midnight snack. Sometimes our timing is off and she's a little high on fasting, but all in all she is much better. Because she is a schnauzer, she's still a little difficult at times, but with the limited ingredients I can tell when the kibble hits her system and can adjust the grams up or down and how many grams to soak when I see a pattern.

[Raysaint]

Re: Struggling with high fastings and short duration of effect of insulin

With the lowest number being 90, but rare, do you think you have room to increase insulin another half unit? Sometimes that much, when you are close to regulation, can make a difference.

When my dog was at 8 units, my vet convinced me to increase to 8.5, and it did help give me less inconsistency, and more good numbers, especially in the morning, which is still my trouble area.

I don't have the consistency I'd like, but fewer numbers in the high range. And once in a while a morning fasting in the real low range, but that's rare.

[Lchow022]

Re: Struggling with high fastings and short duration of effect of insulin

Hi Julian,

I’m having the same problem with my little guy right now.. I’m doing a curve on him today to see what I can do. But I’ll probably post here for help because I won’t know. He’s at 440ish (24.7mmol) fasting this morning. Still trying to lower his triglycerides with his new diet. Been consistent with his new diet for 2 weeks now.

When your dog has higher fastings do you notice a lot more water intake and peeing?
I’m no expert but my vet said if you can keep his highs around 20mmol and under and have his nadir no lower than a 4mmol then you have a bit of room to increase even by 1/4 of a dose. That’s what I did with my dog when he was in the 30’s fasting last week. I only added 1/4 more and it seems to be a bit better but still not good enough..has dexters nadir been at the exact same time everyday? Because my vet was Telling me to just poke him 3 times a day as well. Fastings and nadir but his nadir is not at the right time right now so that means i have to poke him more.

Seems like everyone’s got different methods..hopefully you find something that works. I’ll keep reading your post too because I’m having similar issues..

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

Yes, it's a fine balance between food, insulin and other factors like exercise etc. As of today we are introducing some complex carbs into Dexter's food (brown rice) to see if that might even things out a bit. His kibble and the Honest Kitchen Zeal is pretty low-carb although does have some sweet potato and lentils in it.

Daisy is a mini and I found that she can only have about 19-21 grams of carbs per meal. She had fatty lumps and her triglyceride level was through the roof. She's on a very low fat diet and her lumps have absorbed and her triglyceride level is down.

Although she is on a low carb diet, she does need a little carb during the mid morning-afternoon (around 1130ish, give or take 20 min) to even her out until fasting.

I ran curves on her every half hour to see how she was digesting her food. I found that she metabolized her food very slowly and her nadir was 3 hours after she ate, then she steadily went up in the 500's on fasting. Her food wasn't keeping up with her insulin (Thank you Natalie!!!) and was being used up. I put her on a limited diet (chicken, chana dal, green beans a little kibble) so I could watch how she digested her food. I measure all ingredients in grams.

I speeded up her digestion in the mornings by soaking some kibble and making it mushy (like baby food). Her insulin and food matched much better and her nadir hit around 1145ish but then started to rise and was in the 400's by fasting. I gave her a carb around nadir time and she evened out.

Since I work, I bought an automatic dog food feeder so she can get her noodle at 1130. I actually have two feeders. One is in the kitchen and one in my bed for her midnight snack. Sometimes our timing is off and she's a little high on fasting, but all in all she is much better. Because she is a schnauzer, she's still a little difficult at times, but with the limited ingredients I can tell when the kibble hits her system and can adjust the grams up or down and how many grams to soak when I see a pattern.

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

We had an 8.5 mmol/l (153 mg/dl) at nadir yesterday which means very little room for an increase. Possibly half a unit - I'll post a mini-curve from yesterday so you can see how big the swings are!

With the lowest number being 90, but rare, do you think you have room to increase insulin another half unit? Sometimes that much, when you are close to regulation, can make a difference.

When my dog was at 8 units, my vet convinced me to increase to 8.5, and it did help give me less inconsistency, and more good numbers, especially in the morning, which is still my trouble area.

I don't have the consistency I'd like, but fewer numbers in the high range. And once in a while a morning fasting in the real low range, but that's rare.

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

Hi - yes, more water intake and peeing either side of fasting when his BG goes through the roof. A few weeks ago we were having exactly as you say - fastings of around 20 mmol/l and a nadir of around 6. We could live with that. Now the fastings are well into the 30s (600s) so something has happened - either he needs more (or less) insulin or there is something else going on. It's so frustrating!

Hi Julian,

I’m having the same problem with my little guy right now.. I’m doing a curve on him today to see what I can do. But I’ll probably post here for help because I won’t know. He’s at 440ish (24.7mmol) fasting this morning. Still trying to lower his triglycerides with his new diet. Been consistent with his new diet for 2 weeks now.

When your dog has higher fastings do you notice a lot more water intake and peeing?
I’m no expert but my vet said if you can keep his highs around 20mmol and under and have his nadir no lower than a 4mmol then you have a bit of room to increase even by 1/4 of a dose. That’s what I did with my dog when he was in the 30’s fasting last week. I only added 1/4 more and it seems to be a bit better but still not good enough..has dexters nadir been at the exact same time everyday? Because my vet was Telling me to just poke him 3 times a day as well. Fastings and nadir but his nadir is not at the right time right now so that means i have to poke him more.

Seems like everyone’s got different methods..hopefully you find something that works. I’ll keep reading your post too because I’m having similar issues..

[joolsp]

Re: Struggling with high fastings and short duration of effect of insulin

Here's a mini-curve from yesterday which is indicative of the kinds of readings we have been getting for the past few weeks. Before then his fasting readings were between 19 and 24 mmol/l (340-430) typically.

I should mention that when his fastings are very high we inject around 20-30 mins before food. I realise that is often frowned upon for valid reasons but in the past it has worked for us - gives the insulin a head-start and helps bring his BG down into a good range.

7.15 a.m (fasting) 33.9 mmol/l (610)
(inj 6.5u Novolin N at 7.30 a.m. Food at 8.00 am)

12.15 p.m 14.6 (263)

2.00 p.m 8.5 (153)
(small snack of plain chicken given)

5.00 p.m. 16.8 (302)

7.15 p.m. (fasting) 36.9 (664)

As you can see there are massive swings both down and up. Note in particular the upwards swing between 5 pm and 7 pm of nearly 20 (360) in 2 hours. Too much insulin? Or something else going on?

[Daisydog10]

Re: Struggling with high fastings and short duration of effect of insulin

When Daisy had swings like that I gave her a little carb snack about 1/2 hour before her lowest number. When I gave her protein as a snack it shot her through the roof.