New member Snowball

[RowansRys]

Re: New member Snowball

A disc problem would also make sense of that episode of standing with her back arched (the same position can be a sign of abdominal pain, back pain, or kidney issues from what I remember, so while we thought it could be related to feeding, it may have been related instead to her walking issues and the meal timing was coincidence).

[jesse girl]

Re: New member Snowball

I am not in the camp little bits of food cause blood sugar to spike 300 or more points from a few tidbits of food . I am not sure even 200 point spike can be influenced by a treat

My theory most of our large spikes we see is from the bodies stored sugar . I really dont think dogs dump sugar into the body from digested food directly after eating . There bodies dont work that way i believe

The problem when we test sugar we dont know where blood sugar comes from food or the body it tests the same .

Now food can help preventing the body from responding with its stored sugar say if you gave the treat while sugar was dropping and actually you would want something with a bit of sugar boost and not a completely low diabetic treat that could slow the drop

We have all seen it a drop in sugar and the suddenly a force stopping it in its tracks like a brick wall with a pause and then a spike up

[Raysaint]

Re: New member Snowball

From my experience, treats may not spike 300 points, but it is somewhat dependent on body size. A carb biscuit type treat might not affect a big dog too much, but a small dog is going to have a bigger spike. It is somewhat relative to body size, same as meal size/food portions.

And as we know, it's hard to say how much it spikes them, but any carb can have an effect, so while you're trying to get some consistency and find the right food and dose, like others said, leave out any variables. Especially if given at random times. You're trying to learn her typical sugar pattern during the 12 hour period. Random carb treats will vary sugar readings at different times.

I'm inclined to think the treats are affecting the blood sugar, not stored sugar, which should only be released when the body senses it needs energy and sugar is low.

Maybe go with pure protein type treats {freeze dried liver) and very sparingly. Stop any carb treats and see what happens over the next few days. Lots of experimenting happens in diabetes.

[robl45]

Re: New member Snowball

today 296 9am

373 11am

500 1pm.

404 3pm

This is on 2.5U. She did eat later today. She ate a little at the house before I left and I gave her the shot at about 7am and took her food with me which she ate probably a little before 9am. Could that be causing the huge jump in numbers?

The person who gives treats is not here today so she didn't have any treats.

[RowansRys]

Re: New member Snowball

Did you get a number before the insulin shot? Someone else will have to chime in on whether the shot at 7 with a little food and the rest of the food at 9 can work ok, I always gave the shot right after a full meal.

[robl45]

Re: New member Snowball

Did you get a number before the insulin shot? Someone else will have to chime in on whether the shot at 7 with a little food and the rest of the food at 9 can work ok, I always gave the shot right after a full meal.

No, wife didn't want me to take a sample yesterday morning as she was convinced that was causing the dog not to walk. It didn't make a difference.
314 this morning. Thats like 475 on an alphatrack. Staying relatively consistent in the morning but I need it lower.

[robl45]

Re: New member Snowball

197 at 10am
401 at 12PM

This is with 3 units of insulin. I can drop it back to 2.5U, but the blood sugar isn't dropping. by my estimates on this meter assuming .66 factor, the readings should be around 80 to 150 or so.

[RowansRys]

Re: New member Snowball

Excuse the long post, I went over all your numbers from the very beginning.

First a question: has any progress been made to getting Snowball on 2 appropriately measured meals? I know your wife was wanting to give her more than the suggested amount. I tried to look up the exact numbers for that food but could not find a chicken kibble on the Taste of the Wild website. If it's similar to their others, then about 3/4 of a cup a day would be a good amount given her age and difficulties getting exercise at this point. For standardizing the amount and making sure she's hungry enough to eat it as a complete meal, I would say 1/3 per meal to start, and then increase if her weight drops too much. I will say that most people are used to seeing dogs on the chubby side so I am sure that Snowball would reach a weight that people are uncomfortable with long before she was at any risk of being too thin, barring other health issues causing wasting.


I can see why you're saying that the numbers have been "relatively consistent in the morning". However, I think that her numbers throughout the day are pointing to her insulin dose being too high. Here's my reasoning:
First, the vet curve data. Because the data for 7/14 is not clear as to why it was consistently that high, I am not basing anything on that. 6/16 on 1u was steadily in a narrow range, but higher than we want to end up (306-366, a 60 point range, maximum 2 hour change of 54 points). 6/24 on 2u had oddly higher numbers than the 1u, and a slightly wider band, with a larger drop from the morning number (132 point range, with a 95 point drop over 2 hours). On 3 units we had the widest range and the most severe drop, despite seeing numbers that would look "normal" without the context of the starting number. This gave us a 254 point spread, with the highest drop being 309 points, 254 in the first HOUR of that alone. I would love to have seen longer data (full 12 hours) from the vet, but I'm guessing this was constrained by their office hours?


I would be interested to know if anything changed in her feeding routine or food between 6/16 and 6/24


Moving on to home testing numbers (understanding that the meter has it's accuracy limitations at the higher end, but looking at the overall trend):
10/3 she started at 288, dropped 160 points over the first 2 hours, and then climbs steadily 260 points over the next 9.5 hours until before the next shot it's 110 points HIGHER than it started in the morning. This was on 3.5u.
Following that, we have a mild decline after the dinner shot, and no data until the following morning reads HI. If that HI was accurate, we have a rather steep drop to her next reading of 317 2 hours later, followed by a 75 point climb (2 hrs) and the next 2 hrs are basically flat, then it climbs another 100 points, then I'm not sure WHAT happened? It appears that it then DROPPED 250 points over the next 3 hours to a reading of 258 at 6:15pm which should be before her shot...

The next day is listed at 2.5u, which her numbers appeared better (starting at 259, down to 145, then 187 and 296) until her treat and syrup at 2:30 because you thought she might be hypoglycemic, after which her numbers climbed from 343 (3pm) to 444 (8pm just after the shot and food), and then back to 244 at 10pm.

10/6-10/7 looked good for what data we have. 10/8 was slightly higher, but I'm guessing the 358 reading at 6pm is what prompted you to go back up to 3u?
10/9 on the 3u, she starts at 247, drops 75 points (2hrs), comes up 20 points (2 hrs), and then proceeds to shoot up 170 points (2hrs) and another 200 points (the next 2 hrs), up to 558, after which we don't have any data for the rest of the evening. At this point, my guess is that after dropping the 75 points, what we don't see in the 2 hour gap is a continued drop, followed by an upswing that brings us back up to something that looks "flat" over the 2 hours but may have actually been quite steep, given how it responds over the following 4 hours.

The next morning sees us at 296 at 9am, however that is 2 hours after the insulin shot and only a few minutes after she's eaten her breakfast, and we do not know what the number was before the shot (2.5u?). The number then climbs 210 points over the next 4 hours, before falling 100 points in 2 hours (404 at 3pm). Which is the last data listed until this morning.



I have to say I now agree with whoever said that the vet overshot the mark by going up whole units between 1 and 2, and that her dose might actually be far more stable at 1.5u (possibly 2, but 1.5 looked like a sweet spot between 1 (even, but in the 300's) and 2 (slightly less even and oddly worse, 300's and 400's). If you could drop her back down and hold there WITHOUT changing it for a week, and get her food intake evened out and run another curve that would be ideal.

Shoot, rain and I'm outside....

[robl45]

Re: New member Snowball

EDIT: If what you say is true. How do we explain the last curve when I did the shot in the office and she leveled right out to the 100's at 3 Units? Could my Insulin be bad? I asked the vet about this last time and they said after 30 days we should throw it out, but the new bottle we got didn't seem to make a difference and many people have reported using the insulin as long as its refriderated up to the expiration date/.

First curve 6/16/2018 she was on 1 unit.

8:40 320
10:56 366
12:56 360
2:56 306

They had me increase to 2 units

6/24/2018

8:30 472
10:30 377
12:50 340
2:40-406

Said increase to 3.

7/14/2018

8:30am 516
9:30am 435
10:30 536
11:35 516
12:35 606

Told us they didn't think my wife was giving the insulin correctly and said to stay on 3 units.

7/21/2018

They had me do the shot at the vet at 8:25am
8:30am 439
9:30am 185
10:30am 130
11:30am 98
12:30pm 102
2:30 pm 99



Thank you for the info.

Reading on oct 9th at 6pm was 399. I guess I forgot to put it in.

Today is 6:30am 314 3 units at 7am
10am 197
12pm 401
2pm 489

I will happily drop her to 2 but I'm afraid the readings will go crazy, but I'm willing to try.

She is eating normally now. I had to stop my wife yesterday from feeding the dog a third meal. She gets a meal before each shot and it is about 3/4 of a cup per day. I have a 1/2 cup in the bag so I do a little less than 1/2 cup at each meal and a little bit of boiled chicken breast so she eats. We have been on that for this week at least.


Currently she is still having trouble walking. This morning she couldn't walk at all, then around 10am when I got to work today or a few minutes after she started walking again, she appears drunk but she is walking. I do notice that she appears to be having weakness in the front paws as well as the back legs now. I'm hoping that regulating the sugar will get her under control. I'm having a hard time convincing the wife not to put her to sleep. I took a video today to prove that she is walking while she is at the office.

[RowansRys]

Re: New member Snowball

Posting from my car, so only time for the vet curve with the shot at the office- I think they told you to drop back after that because while the numbers “leveled off”, that first plunge down the hill was very long and very fast. 300 points in 2 hours is pretty insane. I would think that the leveling off after that was probably a combination of meal timing and protective measures from the body.

[robl45]

Re: New member Snowball

Posting from my car, so only time for the vet curve with the shot at the office- I think they told you to drop back after that because while the numbers “leveled off”, that first plunge down the hill was very long and very fast. 300 points in 2 hours is pretty insane. I would think that the leveling off after that was probably a combination of meal timing and protective measures from the body.

On the last curve at the office, she ate before going, there was no meal at the office.

[robl45]

Re: New member Snowball

578 at 4pm.

so
630 314
10 197
12 401
2 489
4 578

Dog has had no treats today. She ate her one meal at 6:30 to 7am. I feel like a failure.

[RowansRys]

Re: New member Snowball

I meant by meal timing that she was digesting enough at that point to have enough sugar going into her blood to balance the insulin so that’s why it evened out instead of dropping.

Though you don’t think so, today is probably our best data yet to base decisions on!! Getting her meals regular is so very important so that we can see what’s going on more clearly! I know how hard it is when you want to be able to give them treats and not feel so regimented, so you’redoing REALLY well (for reference, I’ve been a pet sitter for 19 years, so I’ve seen a lot of pet parents at not so fun moments. Deep breath, you’re doing much better than it feels.

Today’s numbers look to me like the best argument yet that she’s past her optimal dose and needs to have her insulin reduced, if you look how it dipped over the 3.5 hours (and we don’t know from that how low exactly), and then shot up past where it started. I would love to have someone weigh in who’s had the same issue to work with for the “now how do we fix it” part...

I may be able to do more research once I get fuel and get home and changed, I’m soaked to the skin with the hurricane remains hitting New England.

[RowansRys]

Re: New member Snowball

Ok, I was reading around quickly and from the caninsulin uk site:

Hyperglycaemia due to a Somogyi effect can sometimes persist for as long as 3 days after a single hypoglycaemic episode. As a result blood glucose concentrations do not always normalise within a few days of lowering the insulin dose.
If the Somogyi effect is suspected, an alternative approach is to decrease the dose by 20% and closely observe the clinical signs. If signs of polyuria or polydipsia worsen a few days following the dose adjustment, it is unlikely that the Somogyi effect was the cause of the regulation problems. Conversely, if the polyuria and polydipsia disappear within a few days it is probable that the Somogyi effect was the cause.
Either of the following blood glucose curves indicate Somogyi effect:

• Hypoglycaemia (low nadir) followed by rebound hyperglycaemia. [or BG dropped into actual hypoglycemic range, and then shot up high]
• A rapid decrease in glycaemia with an adequte nadir followed by rebound hyperglycaemia. [Snowball's version- drops down quickly but to what looks like a "good" number, and then shoots way up again]

In this case, going from either the 3 units or 2.5 units you end up roughly at 2 units, so I would feel safe trying that amount if it were my kiddo. I do not know if it would be better to drop back to the 1.5 or not, but I would think 2 would be better than not changing. Please note above that her numbers WILL NOT immediately look perfect, or possibly very nice at all (I have looked many times at the tester screen with numbers in the 400's and 500's while we were figuring out Bean's dosage). But in this case, we need to get her to stop having large drops and then rebounding, before it turns into an all out hypoglycemic crisis. High sugar while being treated with insulin is far less dangerous than messing with hypoglycemia. So I think the only thing to do is grit your teeth through it, and do a full week at a lower number and see where she stabilizes with that, and then do a full curve and see what's going on before deciding to change anything at all.

That's my .05 (inflation, you know)

[robl45]

Re: New member Snowball

At 6pm last night she was at 404.

This morning at 630am she is at 264 with 2 units given last night