Sweet Bob the Yorkie has passed 08.08.13

[peggy0]

Re: newbie needs some input

I don't think the Karo effect would still be around at this time. He could have gone too low and then rebounded. Going back 75% isn't an option at this low of a dosage, but I would not give a shot and test him throughout the day to see where he is.

[CarolW]

Re: newbie needs some input

Craig - I think rebound is a possibility I have nothing like the breadth of experience Natalie and Patty and Peggy have. Another factor that might be involved is something called "pre-dawn syndrome," where BGs are elevated around dawn - seems to occur in humans and dogs too. I don't have a link for that, but there is one; on the other hand, I really don't think at this point it much matters.

My feeling is that Bob has had low readings - and Karo - and extra food for several days, causing a kind of instability in his system, and that aiming at consistency will be your and Bob's best friend at this point.

My vets have so often remarked that Kumbi did so well because we were SO consistent. I tend to agree with them, only because they know more than I do, and Kumbi did very well for a long time on a rock-steady consistency. We had some high readings along the way; I just ignored those, and Kumbi would stabilize nicely on his own. We had low readings extremely rarely - at the expense of accepting some high ones.

I kept in mind that high BGs aren't anything LIKE as dangerous as low BGs. And Natalie's point about repeated demands on the body's emergency hormone releases is, I think, a major part of what you would need to consider.

If this were me, I'd do all I could in the next couple of weeks to keep all else about Bob's life (besides food, insulin and testing) just as stable as possible. You might need, of course, to vary amounts of insulin, but I think it would be good to be conservative, and NOT to try to reduce higher BGs in the next few days, but I WOULD keep checking for ketones.

I know it's scary, Craig! But I think Bob hasn't yet had a chance to stabilize, so in your place, I'd follow Natalie's advice - and please keep reporting back, because you have a lot of forum members rooting for you and Bob, and wanting to know how things are going.

Mon, 22 Nov 2010 06:51:11 (PST)

[SeattleCraig]

Re: newbie needs some input

7:30am - "hi" - twice - meaning over 600.

skip his insulin and measure throughout the day?

it's hard to do nothing, but I will if that's what y'all recommend.
I could take him to my vet, but why? She'll dose him. I'm sure of it.
Aside from drinking lots of water, he's looking pretty good.

Keep in mind that he's still on SubQ fluids for his BUN's and creatine, which tested normal last Thursday. Ketone strip has been negative the past two days, but I haven't tested today (will do-- his next pee).

[SeattleCraig]

Re: newbie needs some input

Thanks, Carol.

Bob is only eating by dropper at the moment, his physical activity is nil (beyond going out to do his business), and the rest of the time he naps. He's getting the same amount of food by dropper at 8:30am and 8:30pm.

I had to chuckle, though, because if he gets any more consistent, I'll be checking his vitals for signs of life.

I do understand what you're saying, though, and I appreciate the emphasis on "highs" being better than "lows", always. I think that's my new motto.

The only thing changing in Bob's life at the moment is his insulin dose. =)

[k9diabetes]

Re: newbie needs some input

If you haven't already, give him something more than zero insulin and less than half a unit with his breakfast to bring his blood sugar down out of sky high territory. As close to a quarter of a unit as you can measure.

Then discontinue insulin - none tonight with dinner.

I would tell the vet what's been going on with him.

But under no circumstances would I allow him to be injected with insulin beyond the quarter unit this morning. We need to see what happens when he is given no injected insulin.

Sorry this is such a rollercoaster ride...

Natalie

[SeattleCraig]

Re: newbie needs some input

done!

I was going with nothing, so I'm glad I caught you.

I'll report back through the day, but will plan on nothing tonight.

(it is a rollercoaster ride, but I'm interested to see what will happen with no insulin, too. I'm starting to wonder if you were right re: something else happened, and now that he's through with that crisis, he might not need the insulin at all. Maybe it's a long shot, but I want to know.)

[SeattleCraig]

Re: newbie needs some input

11:30am - 313
1/4 brought him out of the super high zone nicely, without pushing him to the other extreme.

noon: Ketone stick came back just shy of "small" trace. I gave him another SubQ treatment.

[k9diabetes]

Re: newbie needs some input

How close together are the insulin injection and the subQ fluids?

Since both are subQ, the fluids could, if close to the insulin injection, be diluting the insulin. Diluted insulin typically would be absorbed somewhat faster... though it would also have to compete with absorption of the fluids...

Not really sure what the net effect might be but I think I'd want to keep them as distant from each other as possible.

Natalie

[SeattleCraig]

Re: newbie needs some input

I hadn't considered that, Natalie.
They've been about an hour apart.

I give the Sub-Q at about 8:00, usually a little earlier. I let that absorb, then I start to feed him about 8:30. This takes about 15 minutes, as it goes better if I do it a little at a time.

I let that settle, then give him the insulin at 9:00.

I'll try to space it even further in the future. By the time he's getting his insulin, though, the fluids appear to have long dispersed from his back, and any left to absorb are settled around his chest and underarms (they get a spongy feel).

[k9diabetes]

Re: newbie needs some input

I would space it out not only in time but also in where you inject the two. Are both going in the scruff? If the insulin injection is closer to his neck so "above" the subQ fluid injection site maybe.

[SeattleCraig]

Re: newbie needs some input

7:30am - "hi" - twice - meaning over 600.
9:00am - 1/4 unit
11:30am - 313
noon - keto strip "small" amount; subQ fluids
2:30pm - keto strip down to "trace" amount
2:45pm - 231
5:45pm - 328
8:30pm - 423; more subQ fluids

[Patty]

Re: newbie needs some input

Wow Craig. I have often wished for syringes with 1/4 or better 1/8u markings since Ali's so sensitive to insulin doses. Looks like you'll be another wishing for the same.

I like the lower number but don't like how far he's come down in the course of the day. I'll let Natalie help you through with a plan, but I'm thinking 1/8u and/or multiple feedings to balance the insulin in the future.

[k9diabetes]

Re: newbie needs some input

I definitely think you should skip insulin tonight. See what the blood sugar is tomorrow.

It is possible that even without insulin his blood sugar will continue to drop because the excess from a rebound is finishing washing out.

If he can't get by without insulin, then I'm thinking that possibly 1/4 of a unit once a day in the morning - because he can be supervised when given in the morning - would be worth a try. We did that for a while when Chris was honeymooning. Twice a day was too much but once a day worked well for a while.

But let's see how he does without insulin.

If this is recovery from a rebound, his blood sugar could definitely return to normal on its own.

Natalie

[SeattleCraig]

Re: newbie needs some input

I will skip tonight.

I've upped his fluids a bit to help with the ketones, and it seems to be doing the trick.

What if one of his late night (or middle of the night) tests come back in the 500's, or completely off the chart (>600) like earlier today? Should I still wait until tomorrow morning?

BTW, Patty, I don't think I could pull off a 1/8 unit with these needles.
The 1/4 unit was too tiny to really know how accurate I was. I just know I took it to 1/2 unit, then pushed as gently as I could until it looked right. It took a few tries to get it to where I was comfortable that it was about 1/4.

[k9diabetes]

Re: newbie needs some input

I wouldn't give him insulin in the middle of the night. I would wait until the usual time. This is an opportunity to oberve, not intervene unless there's an emergency, and even if he goes high for a few hours he should be okay.

I'm hoping his blood sugar will drop to normal or close to normal. If he rebounded last night, his blood sugar might still run somewhat high for another 24 hours but we will see.

Natalie