Jessie, Min schnauzer just dx-ed

[frijole]

Re: Jessie, Min schnauzer just dx-ed

Alison I know it is refrigerated - the vet asked them that after week 2 to be sure. I believe that they brought in a syringe for the injection yesterday along with the food.

[k9diabetes]

Re: Jessie, Min schnauzer just dx-ed

There are, rarely, dogs that do not respond at all to human insulin. Kathy's Lucky was one. Jessie's dose isn't high enough yet that I'm necessarily deeply concerned but it's heading in that direction. If she gets up into 17-18 units and the blood sugar still hasn't budged, I would definitely be concerned.

I have also seen a few small dogs who just need a lot of insulin to regulate and maybe Jessie will be one of those.

But...

This picture just doesn't make sense... it seems odd to me that she's stopped urinating in the house even though her blood sugar is still so high.

I wonder if she could be stressing at the vet and that's artificially raising her blood sugar?

It doesn't happen all that often with dogs, not nearly so much as cats, but it is a possibility.

This is one time where a fructosamine test might help confirm or put to rest the possibility that her blood sugar at home is different than her blood sugar at the vet.

I sure you wish you had your hands on that dog... something here is not right but I don't know that from such a distance we will be able to figure out what it is.

Natalie

[frijole]

Re: Jessie, Min schnauzer just dx-ed

Nat, appreciate your thoughts as always. I am torn because I can only get so involved yet my heart goes out to Jess. My mom replied that no Jess did NOT go in early (I swear my stepdad told me he was opening up early and thus my post) and she had her food and shot before going in and thus the 8 am reading.

She said that the vet said it wasn't necessary to do a whole days curve but he would if they wanted him to.

I took my dog in for an acth test for her cushings today and didn't see the vet but the front desk was "ice cold". This is not going to be fun. Kim

[frijole]

Re: Jessie, Min schnauzer just dx-ed

Update on Jessie's latest curve at the end. Progress?

4/5/10 she had 6 units at 7 am

8 am 570
11:30 am 362
1:30 pm 398

increased to 8 units for next week

4/12/10 she had 8 units at 7 am

9 am 552
11 am 560
1 pm 580

4/26/10 she had 10 units at 7am

8 am 530
10 am 480
12 pm 402
2 pm 458

increased to 12 units

5/3/10 she had 12 units at 7 am

9 am 225
11:45 am 172
1:45 pm 108
4:30 pm 414

Dosage stays the same for 2 weeks and then another curve check

Kim

[peggy0]

Re: Jessie, Min schnauzer just dx-ed

Well the numbers between 10 and 12 are quite different. I'm a little concerned about the 108 to 414 and wondering if she dropped too low in between. If it were me, I'd go to 11 and spot check her.

[Patty]

Re: Jessie, Min schnauzer just dx-ed

Kim,
I'm with Peggy, the 1:45p to 4:30p is suspicious of rebound. If she went quite a bit lower than 108 between those times, her counter regulatory hormones may have kicked in creating the high of 414.

I know we lost some "cred" with the folks before when expressed concern but I'd be concerned she could have gone too low this afternoon. But then we've never had a 4:30pm reading before either to know whether duration is just being cut short.

While these curves are not complete 12-hour curves, take a look at the range of numbers reported previously:
4/7 on 6u range of 208 from highest to lowest number reported
4/12 on 8u range of 28 points (she rose this day where other days she dropped)
4/26 on 10u range of 128 points
5/3 on 12u ranged of 306 points

Definitely progress in lowering bgs...but I'd like to see her on 11 units as Peggy said with those numbers. See what Natalie has to say
Patty

[k9diabetes]

Re: Jessie, Min schnauzer just dx-ed

On the face of just those numbers, I can't tell whether it's rebound or lack of duration or just a very sharply shaped curve where the insulin food balance is out of whack so it starts high, goes low, and goes back to high.

It is a great example of the kind of curve that would make a fructosamine test completely meaningless!

I'm thinking they might be very willing to give Jessie a snack in the afternoon. Based on this curve, that's what I would suggest to them if they were listening to me . A mid-day meal. Not too big, at about noon.

I know they will think you're nuts to tell them now to give a snack. But the joy of it might make them overlook that!

A snack at noon should in theory help level out the blood sugar early in the afternoon. And if a snack was given at noon, those afternoon readings would give us the answer to the rebound/duration question.

If rebound, the late afternoon readings improve by eliminating low blood sugar.

If lack of duration, the late afternoon readings get worse cuz there's even more food than before at a time when there's not much insulin action.

Curves at the vet don't always reflect things at home either, which is among the reasons I like home blood glucose testing. They are usually shut in a cage with no activity, nervous, bored... it's just not anything like the home environment / activity level.

If rebound could be ruled out, this would not be ideal but it could be lived with if need be. Probably a lot of dogs who aren't tested have curves like this. As long as the forays into higher numbers are brief, it's not the end of the world. But the trick, again, is make sure it isn't rebound and the stores of backup of glucose aren't being depleted by repeated emergency responses.

Natalie

[frijole]

Re: Jessie, Min schnauzer just dx-ed

If rebound, the late afternoon readings improve by eliminating low blood sugar.

If lack of duration, the late afternoon readings get worse cuz there's even more food than before at a time when there's not much insulin action.


Natalie

So you are thinking a snack midday would lower that afternoon number? Not sure what you are saying regarding lack of duration. English please?

They feed her 1/2 c kibble morning and night and have been giving her green beans as treats. Are you suggesting a bit of kibble at midday? If so - approx how much? Its easier if I can give them specifics and the why.

Thanks!

[Patty]

Re: Jessie, Min schnauzer just dx-ed

Hi Kim,
Lack of duration would be when the insulin doesn't last quite 12 hours. Food can have an effect on duration of insulin. So if a snack is added and the blood sugar goes up earlier and further than before, it may be that duration was the issue and the snack is shortening the duration even further.

But if we think the blood sugar is going lower than 108 at 1:45pm, a snack should prevent the low and possible rebound situation. So, hopefully you wouldn't see the higher number in the 400s because the counter regulatory hormones wouldn't kick in from blood sugar that had gotten too low.

I hope that explanation made sense.

Natalie suggested a snack at noon. I'm not sure what she was thinking as far as what type of snack. When Ali was on kibble and had a dip in the afternoon I used a regular size bone, like what a milk bone would be to prevent her low.

Patty

[k9diabetes]

Re: Jessie, Min schnauzer just dx-ed

This insulin lasts "about" 12 hours, which is why we give it twice a day. But like all meds, it's never exactly twelve hours and it varies from dog to dog. Our dog got only 8-9 hours out of NPH - so for him it had a short duration. Once it was gone, his blood sugar would start climbing.

The goal of the snack is to raise her blood sugar between noon and 5pm to get rid of any low blood sugar that might be causing a rebound.

You would just have to guestimate how much of a snack to give... start small. Maybe 1/4 of the size of her meal or less. As Patty mentioned, sometimes just the size of a single biscuit can be enough. I would be really conservative at first.

Are they doing any monitoring at home? Any urine testing?

Natalie