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Diabetes and Regulation in General The big picture of managing and regulating a dog's diabetes

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Old 04-25-2011, 11:09 PM
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k9diabetes k9diabetes is offline
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Default Re: Hattie's diagnosis

I haven't had a chance to read through today's discussion in detail but have a couple of thoughts after a brief skimming of it.

First, this might sound crazy to you right now but I've seen a lot of people who would fall down to the ground in thanks if their dogs' blood sugar ever consistently fell into the mid-200s. Harry's mom, Yunhee, is one who didn't see numbers that good for months because Harry has a lot of other health issues that have made him very difficult to regulate.

And Harry's vets are really great - he has a regular GP vet and an internal medicine specialist - but neither one of them was the one who understood the interplay of food and insulin well enough to formulate a plan that worked for Harry. A holistic practitioner who understood how adjusting diet and the timing of insulin and exercise was the one who figured out a plan that significantly improved Harry's blood sugar through some simple diet changes and timing changes.

Dogs don't have to have perfect blood sugar to live long healthy happy lives. I've seen a lot of dogs who never got blood sugar lower than the 200s and they did absolutely great.

Is it worth trying to get the blood sugar lower? Yes. Absolutely.

But if it never gets any better, it won't be the end of the world - or your dog's life or happiness.

And it definitely is not a reason to panic and rush to change the dose.

It is much much better to take the time to sort out what's going on with Hattie all day instead of at just one point in the day.

I know that might be hard to feel comfortable with....

For a little more perspective, it took my dog more than a year to regulate properly! He had some problems with the way he used insulin and his blood sugar went from 100 up to 450 and back down to 100 again in 12 hours.

If I had checked his blood sugar at the midpoint of that rise and fall, I would have gotten a level in the 200s. I would not have known that it was going to drop another 100 points in the next few hours. And if I had given him significantly more insulin without knowing that, he would have gone hypoglycemic in a hurry.

You can read more about Chris' blood sugar, the sharp drops and rises in his curves, and his road to regulation in his case study:

Once we found what worked for Chris, he went on to have really great blood sugar and he lived to be 14.5 years old, a serious senior for a dog his size (62 pounds).

Diabetes didn't kill him and the truth is that diabetes almost never kills a dog. The only time I have seen diabetes kill a dog was from overdoses of insulin. Our dog died of cancer and suffered from severe heart disease for years, heart disease that preceded his diabetes diagnosis. Diabetes, even as difficult as his was to control, was literally the least of his problems.

So Hattie will be fine. She will be fine even if you don't raise her insulin at all for a few days. There is time, plenty of time, to take a methodical approach to her insulin dose.

I understand the panicky feeling... truly I do. I will try to remember to share my diabetes panic story with you! But Hattie is okay and there's really no need to panic. The worst decisions are made in panic - that's how you wind up giving too much insulin and getting started on a rollercoaster ride of highs and lows.

The best thing you can do for Hattie right now is set aside your fears and work the problem, learn to read Hattie's "book" with curves of her blood sugar.

Old 04-25-2011, 11:25 PM
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k9diabetes k9diabetes is offline
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Default Re: Hattie's diagnosis

Because home testing blood glucose is new to many vets - and there are lots of vets who still refuse to use it - those vets do not necessarily understand curves. They have been taught in many cases that every dog's curve is a bowl-shape with the lowest blood sugar at 6 hours. That's it - all dogs do the same thing.

Which, if you give it a couple of minutes of thought, you realize pretty quickly that all dogs doing the exact same thing with a medication doesn't really make sense. After all, does your body use food or medications or exercise exactly like everyone else on the planet?

I've been involved with forums for canine diabetics for 7 years now and I have seen every kind of curve imaginable!

Some dogs do the classic bowl. But even that can vary in how deep the "bowl" is. Most of them, unfortunately, do not have incredible level blood sugar throughout the day. So sometimes they can start at 450, drop to 80, and then rise back into the 400s.

Some dogs do mountain-shaped curves, as our dog's curves were on the first insulin he was given. His lowest blood sugar was at meal time and then it just climbed and climbed and climbed, hit the top of the Alps, and plunged back down.

I've even seen double-humped camel shapes with two peaks and two low points of blood sugar.

Complicating things further...

It's a nice idea that we give insulin every 12 hours and it lasts exactly 12 hours... also doesn't make too much sense if you think about it from your own experiences. Some dogs get 8 hours (ours), some get 12-13 hours (Yay!), and some get 14-16 hours from an injection.

I understand why they teach a tidy little picture in vet school. But life is not a tidy little picture! And dogs don't read the books.

So I view every diabetic dog as his or her own "book" and the best way to regulate your diabetic dog and give her the best life and the best blood sugar possible is to read her "book."

That book is written in curves.

When you know how high her blood sugar is going and you know how low her blood sugar is going and you know approximately when those highs and lows occur, THEN you will truly know what you need to know about changing her dose.

The lowest blood sugar always has to control the insulin dose.

That's a really important - and sometimes difficult - concept to get. But it's absolutely crucial.

Because every time you increase the insulin dose, it isn't just the highest levels that come down. All of the levels come down.

So if my dog's blood sugar starts at 450 and drops to 80 and then rises to 450 again, those 450s don't matter.... because if you give more insulin, the 450s won't be all that drops. The level of 80 will drop too.

And I'm afraid that very little of this kind of information is transmitted to vets. Some pick it up on their own. Many don't. This kind of regulation is only starting to become standard practice for canine diabetics, transferred over from how people are regulated. Before home testing, a vet would often try to never let your dog's blood sugar get below 250... yes, below... because no one was testing it and they feared low blood sugar more than anything else. With some justification.

Thanks to meters, we can do better. But only if we do the leg work - curves - to do it right.

Old 04-26-2011, 02:27 PM
Unforgiv Unforgiv is offline
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Default Re: Some of the core ideas behind regulating a diabetic dog

Very instructive. Very helpful. Thank you so much for sharing this information and Chris' story. I'm having to manage my situation with my buddy Joe Cooper with little vet interaction (I'd prefer more, to be sure -- but our situation doesn't allow it). I'm reading so much daunting information, but this was eminently readable and easily understandable.

Thank you, thank you, thank you!
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