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  #41  
Old 02-04-2009, 10:35 PM
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Default Re: Pip's Story

How's Pip doing?

Natalie
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  #42  
Old 02-05-2009, 08:13 AM
pgcor pgcor is offline
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Hi Natalie:

I'm really, really confused with him!!!!!! Today is his curve. We have not gotten any negative readings on his urine test for about two weeks.

First draw at the Vet was at 7:45 and this was fasting and no insulin and a full two hours past his 12 hours - 97!

Next draw at 10 - 49!

I know he can drop from being nervous, but how are we supposed to know how to adjust his insulin? These are really low numbers that do not correspond to his urine tests. I know that bg and urine are different, but at these numbers he should not have showed any sugar in his urine!

I'm just shocked at these numbers. I only wish my husband could have checked his urine because that would have confirmed to me that he was dropping due to stress, but as usual, he was unable to get it. I could kick myself for not getting urine this AM before I went to work. But I didn't want to get Pip up because he can't eat. Better to stay in bed with my husband. Or at least that's what I thought.

Well, we have the rest of the day...but geez

Pam
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  #43  
Old 02-05-2009, 09:08 AM
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Default Re: Pip's Story

Pam,

First of all, if Pip is getting a curve done without food and insulin, what you are not seeing is the blood glucose elevations which come from whatever one eats, so you're really looking as his basal--body's needs without bringing food into the picture. You more than likely are seeing some stress response while there factored into it also.

What you are most accustomed to seeing is Pip's urine tests when he eats normal meals, the food we eat is a lot of what drives bg's up and that's where the insulin has to come in to control them.

In the years before insulin was isolated, there was nothing you could do to try to keep people with diabetes alive except to put them on what was known as a "starvation diet". It was known that the food they ate would drive their blood glucose up because of their non-working pancreases, so they were to eat just about enough to keep alive. After insulin was available, those with diabetes were able to enjoy a more balanced diet because they could eat sensibly and use the insulin injections to keep their blood glucose controlled.

The body requires some insulin to stay healthy (Which is why we always are talking about the need to give some insulin even when the pet either doesn't eat or eats only part of a meal.), but the real "bulk" of the job the insulin does is to handle the food that's eaten.


This is an illustration of the insulin secretion of a person who doesn't have diabetes. Where you see the "spikes", note that they come in response to having eaten a meal. Those very low levels of insulin secretion you see are in response to the body's basal need for insulin. If we vary our thinking just a bit and view the graphic in terms of diabetes, I think you can see when and where the real "demand" times are to have substantial amounts of insulin--after meals.

Now let's go a step further and try to look at the graphic in terms of it being blood glucose levels instead of insulin secretion. The process of higher blood glucose levels begins at about 2 hours after eating; this is when most people with diabetes check their blood glucose to see how they're doing and if they might need a small corrective dose of fast or rapid insulin in addition to what they had used to cover the meal.

If one ate little to nothing, there would be very few problems with controlling blood glucose levels.

What you might want to share with your vet are your records of Pip's urine test results. This is some way to view what he's doing when things are normal and food is added.

For the most part, what you are seeing when you do urine testing is "delayed reporting results".

http://www.pueblo.gsa.gov/cic_text/h...etes/check.htm

"However, urine testing is not completely accurate because the reading reflects the level of blood glucose a few hours earlier."

Basically, then, what you're seeing re: urine readings would have been present in his blood earlier if you had tested it. The reason blood testing is preferred if possible is because it gives you an "up to the minute" look at the amount of glucose in the blood at present, while urine test results are "slightly old news".

These home urine test results might be helpful to your vet by way of comparison of them against the hospital curves.

HTH!

Kathy
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  #44  
Old 02-05-2009, 09:30 AM
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Default Re: Pip's Story

Hi Kathy:

We like to get a fasting bg on Pip at the beginning of all of his curves. It's the only time we test his blood and then we can compare his fasting number in the AM and PM to make sure he's on track. Is that not something you would do?

Even considering the delay in urine - based on the 97 blood test, wouldn't you expect his fasting urine tests to have been negative?

I thought there would be at least some correlation between the fasting urine and bg test. If you're below the renal threshold you should be negative, no matter what test you use. Am I correct in my thinking?

I'll post the rest of the curve as it comes in. I wish I was home and could bring Pip to the Vet myself. I told my husband to bring in the urine results, I'll have to see if he does it. (Doesn't like being told what to do!)

Thank you so much for all the information Kathy!

Pam
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  #45  
Old 02-05-2009, 10:03 AM
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Default Re: Pip's Story

Pam,

I would believe that if you'd done a urine test for Pip this morning, you would have gotten a negative too.

If you're below that renal threshold, as you said, you would be below it whether you were testing urine or blood. The glucose starts going into the urine at the "threshold" and will be seen if you pass that point and stay there for a while. While your urine stick will show a negative, using a meter would put you somewhere below 180 mg/dl.

If Pip's urine tests didn't make it there, you might be able to send them to your vet via fax rather than "via DH".

We'll be waiting to see what Pip's willing to tell all of us!

Kathy
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  #46  
Old 02-05-2009, 11:43 AM
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Default Re: Pip's Story

It may be that curves are just too stressful for Pip. In which case you might as well skip them and save the money! (well, and the stress too, of course!)

This is the one time when a fructosamine test may be of some value. It could potentially confirm your urine test results.

Otherwise, I'd just stick with urine tests and see what you can do working at the "edge" of the threshold for glucose spilling into the urine.

If you start getting negative tests, you can drop back just a tiny bit on the insulin - estimate a quarter unit if necessary - and see how that affects the urine tests.

If more sugar immediately shows up after such a tiny reduction in insulin, then you can figure that his BG is hovering close to the threshold.

If the urine stays negative, drop it a tiny bit more and test again.

How much you have to drop the insulin to push his blood sugar back over the renal threshold can give you an idea of how far below it he has been while testing negative on the urine strips.

Then you can adjust with a permanent slight drop in insulin if he seems to be running too far below the threshold.

Hope that makes sense.

You can do sort of the same thing in reverse. If his urine tests always show a small amount of glucose, increase the insulin very slightly... like a quarter unit... and see what that does. If the urine tests drop to negative from a tiny itty bitty increase, he's probably been hovering somewhere around the threshold. If it doesn't drop to negative glucose, he's probably been consistently higher than 180 throughout the day.

Curves are nice but they aren't necessary. Pip wouldn't be the first dog for whom even curves are impossible. So you work with urine tests and whatever signs he shows you and go from there! It sounds like he's been doing well overall, no hypos and limited glucose.

Natalie
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  #47  
Old 02-05-2009, 12:25 PM
pgcor pgcor is offline
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Default Re: Pip's Story

Boy, I'm just not happy with the way this curve is going:

7:45 A - 97
10 A - 49
12 P - 104
2P - 186

Both the Vet and my husband are testing urine too and so far all have been negative, which I would have expected given he's just over the renal threshold now.

I try very hard to keep Pip below the renal threshold and I've been fairly successful until I changed his food amount. I suspect the 4 and 6 readings will be high.

In the past, Pip's nadir was always noon. We dropped his food volume by 15%, I believe last Friday - but could he still be adjusting? I did not mess with the insulin amount and he is still at 6.5 units.

The Vet also said Pip's weight stayed the same!!! I find this hard to believe. His weight is 21.8 and he should be 23 lbs. He looks so much better! Maybe wishful thinking on my part. She claims her scale is accurate - but I wonder? I weighed myself on one of those dog scales that are built into the floor - and I must say - I was at my High School weight again! But, I would hate to have to try on my uniform from those days.

Natalie, I see what you're saying about the curves. At this point, I'm too nervous not to test him... If he would let me do this at home, he'd be a lot better off.

Ugghh, I hate diabetes!!!!!! Love you guys though!

Pam
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  #48  
Old 02-05-2009, 01:03 PM
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Default Re: Pip's Story

It could be that if you're going to keep the food decrease, there needs to be a bit of an insulin decrease too. Maybe trying to go from 6.5 to 6 units and see if those numbers look better to you.

Of course, we might all have different thoughts once we hear Pip's side of the story later on!

Kathy
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  #49  
Old 02-05-2009, 02:14 PM
pgcor pgcor is offline
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Default Re: Pip's Story

Pip's last draw was 301!!!! Now the Vet is telling my husband that maybe we should give him his shots at 6AM and 4PM. That's ridiculous. Would you think rebound, given the large increase from 186 to 301? Kathy, maybe a decrease to 6 would help?

I don't know, maybe it's his diet again?????
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  #50  
Old 02-05-2009, 03:06 PM
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Default Re: Pip's Story

A rebound is certainly possible from that 49 this morning. That would be low enough to potentially trigger a release of glucose.

Honestly, I don't think I would base any decisions on this curve - nothing on the high numbers at least. Once it dipped into such low territory this morning, everything that comes after is suspect.

The vet is most likely thinking that the low number this morning and high number this afternoon suggests that the insulin is lasting longer at night than during the day time. I can see the logic of his suggestion given this curve. It is a possibility.

But I still don't think you can depend on this curve for accurate readings after the low occurred.

IF the first blood draw was done as soon as Pip got there, quickly, quietly, no waiting around, minimal stress... then I would put some credence in the fasting of 97. But without a urine test to back it up...

I think your best bet would be to work with Pip at home with urine testing. And you might have him do the fructosamine test just to see what Pip's overall average blood sugar level has been.

Some small diet tweak might help.

It's hard when you're working with a small number of units to adjust insulin in small increments. At 6 units, adding 1 more unit is a 16.6% increase. If a dog was getting 20 units, that would equate to a more than 3 units. Adding one unit to a dog getting 20 units is only a 5% increase.

So -Food Quantity A and 6 units- might match better than -Food Quantity B and 6.5 units- just because the changes don't quite match each other.

Food changes are always tough and take time to sort out.

You won't be able to enjoy Pip, though, if all you do is stress about getting him back to a negative urine test. So don't forget that Pip can live a long healthy happy life even if you never get all his urine tests under the threshold and that the most important thing is to spend some energy letting Pip be Pip and you absorbing all of the joy that brings.

Natalie
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