Blue's Journey

[blue]

TWO MESSAGES COMBINED HERE SO SOME REPETITION - Natalie
_________

my min-pin who is 10 yrs old has been on vetsulin and now we are trying the humlin again. He's on a home cooked diet of vension and green veggies. I am having a hard time with his levels, this am 3 hours after his shot and feeding his reading was 198. blood sugar continued to get higher during today with last reading 9 hours post am shot at 498.

he is on 6 units, the vet started him at 2 last week and i have slowly gone up. he takes 2 shots per day. my question is would it help or hurt to give a mid-day snack? sorry for this being so long we are new to this form. please help us if you can.

thanks
_______________

just changed over to humlin, vet said to start with 2 units after being on 5 units of vetsulin. having a hard time getting getting below 300. have increased to 6 units by now. 3 hour post injection and food this am was 198, but by 9 hours post injection 485! not sure what to do and neither does the vet. He stated that they were having a horrible time with the other dogs trying to regulate. My question is ... should he have a snack during the day?

I would truely appreciate any help you can give.

[k9diabetes]

Re: need help!

Hi and Welcome!

I combined your two posts together when I approved your membership.

Have you had a chance to do a curve with him on NPH?

It would helpful to know what his blood sugar does throughout the day. And it would help determine if a snack would be helpful for his blood sugar and, if so, when a snack would help.

You would aim a snack for the lowest point of his blood sugar AND you have to give it about an hour before so there is time for it be digested.

So if the blood sugar plunges as soon as he gets his shot and breakfast, a snack won't help that and will cause higher blood sugar later.

Hope that makes sense!

Natalie

[eyelostit]

Re: need help!

TWO MESSAGES COMBINED HERE SO SOME REPETITION - Natalie
_________

my min-pin who is 10 yrs old has been on vetsulin and now we are trying the humlin again. He's on a home cooked diet of vension and green veggies. I am having a hard time with his levels, this am 3 hours after his shot and feeding his reading was 198. blood sugar continued to get higher during today with last reading 9 hours post am shot at 498.

he is on 6 units, the vet started him at 2 last week and i have slowly gone up. he takes 2 shots per day. my question is would it help or hurt to give a mid-day snack? sorry for this being so long we are new to this form. please help us if you can.

thanks
_______________

Are you on 6 units of NPH now? The vet started out at 2 units last week and went up to 6 units of NPH by this week, is that correct?

How much does does your doggie weigh and can I ask how much food are you feeding?

I'm just concerned if this is a small dog and that the vet increased the dose from 2 units of NPH to 6 units in a weeks time.

I cannot tell without seeing a curve, could be a treat is needed at 3 1/2 hrs after shot or even a small amount of dry food with meal.

Have you checked bg again?

Hang in there
Dolly & Niki

[blue]

Re: need help!

started humlin on jan. 12 at 2 units after pm feeding. readings stayed in high 300's, jan 13 before pm feeding 371 gave 3.5 units. 3 hours after eating 321. gave additional unit. Jan 14 gave 4.5 units in am and before pm feeding reading was 365. 3 hours later reading 251 after increassing to 5 units. On Jan 15, 5 units given in am, 3 hours after shot reading was 326, 6 hours 270 small piece of jerky given, 9 hours after shot 275. gave 5.5 units after pm feeding. 3 1/2 hours after shot 370. Jan 16 gave 5 units am. 31/2 hrs after shot 266, 7 hrs 404, 1 hr before pm eating 324,after eating gave 6 units. 3 hrs later 295. Jan 17 gave 6 units after am feeding, 3 hrs later 198, 6 hrs 328, 9 hrs 485. 3 hrs after pm shot 350. 4 hrs after shot gave peanut butter and cracker.Jan 18 fasting 273, gave 6 units am, 5 hrs post injection 98, gave peanut butter and cheese and chicken treat. 10 hrs post inj. 315. I gave 6 units after pm feeding tonight, planning on cking 3hr post inj. and giving peanut butter and cracker. Blue is 10 years old and weighs 14lbs. he's on home cooked food...venison and green veggies with brown rice and egg. his treats are chicken jerky or cheese. I dont kw if I'm doing this right or not, kinda on my own. feel like his vet is at rope end. I told him i wanted to do the curve at home and he wished me luck that his clinic was not having any trying to change the oter dogs over. please let me know what you think and i will sure take your advise...I need all I can get. just took is reading 31/2 hrs after shot 190, gave peanut butter and cracker, cheese and chicken treat.

[Patty]

Re: need help!

Hi and Welcome!

I just wanted to say it's great you are able to home test.

How much does your dog weigh?

I am very concerned about how fast you are increasing the insulin dose. Any changes in dose need at least 3 days, sometimes longer, to settle in. You may not see the results of the change immediately and over time the insulin dose may last longer potentially creating overlap, which may result in a downward trend. Rebound is another possibility when increasing too fast.

I definitely would not increase any further without doing a full curve to see how the food and insulin are working together - especially with that 98 you got today. As you get close to the dose, you may even want to eyeball 1/4 unit changes if you have syringes with 1/2 unit markings.

Sounds like you are home to keep an eye on him. You may find this dose trending lower. I would watch carefully for this.

Hope that helps. I'm sorry it doesn't sound like your vet is willing to help you on this. Do you have other options in your area? Someone who has more diabetic knowledge and/or has used NPH before?

Take care,
Patty

[blue]

Re: need help!

i was wondering after this last reading of 190 if i need to back off to maybe 5, wondering your thoughts. problem is i work but able to come home at lunch so i sure dont want him to bottom out!all of the vets in this area have been using vetsulin so noone kws much about the humlin

[Patty]

Re: need help!

Sounds like you're getting some nice numbers right now and maybe 6 units is where you will wind up...but being gone during the day, I would probably back off.

That will give you a chance to do a full curve on a lower dose and see how the food/insulin are working together. Then you can evaluate the need to increase again.

How much does does your dog weigh?
What's his name

Patty

[k9diabetes]

Re: need help!

Patty has given you wonderful advice!

I am going to copy here what I just emailed to you so all can see it. You will get Blue back into regulation - just needs a little time and a more methodical approach, something you may want to share with your vet!
___________

Hi!

I'm not sure how much the vet has been involved with your effort to regulate Blue. It seems like s/he is at a bit of loss as to how to go about this.

What I recommend is that people reduce the existing dose of Vetsulin by 25% and start the NPH at that and then monitor three to five days and see what effect you get from that level of insulin.

(To be fair to vets, there was a protocol released by AAHA that called for a very drastic reduction in the dose, which is a good idea in diabetic cats but isn't really needed in diabetic dogs and the person responsible for that protocol contradicted himself in an online conference about how to make the switch. Online, he said "cut the dose a few units" which comes out to something like 25%)

In Blue's case, 25% of 5 units is 1.25 units to reduce the dose by.

So I probably would have gone a little on the conservative side and started him at 3.5 units of NPH.

Then I would have just watched his blood sugar with maybe four tests a day if possible for several days to see what kind of response his blood sugar gave to that dose.

As long as the blood sugar isn't screaming high, like consistently 400 or more, I would wait a couple of days for things to settle and then increase the insulin dose if need be.

Your increases have occurred too quickly and I'm pretty sure 6 units is too much for Blue at least this soon.

On the 14th you had a reading of 251 on 5 units and on the 15th you had a couple of readings in the 270s on 5 units.

That's good!

It also tells you that his lowest blood sugar is occurring around 6-9 hours after injection - a pretty typical time - so that is the time of day to test him to see how low his blood sugar is going on a dose of insulin.

The number of units of insulin you can give always has to be controlled by the lowest the blood sugar goes. Doesn't matter how high it goes.

Well.. it matters, of course!

But if the lowest blood sugar is 90, you can't give any more units of insulin even if the highest BG is 600. Because more insulin will drop the 90 down into hypoglycemia. So it's really important to know what the lowest blood sugar is.

So here is what I recommend.

Go back to 5 units of insulin and no snacks between meals and stay at that amount.

Test the blood sugar but don't try to "correct" it by giving more insulin.

Just observe and record the blood sugar levels and only respond differently if his blood sugar is low, which of course you have to treat.

After he has been on 5 units for 4-5 days (to make sure any effects of rebound caused by suspected low blood sugar are cleared) with no low blood sugar noted, do a full curve with premeal BG readings and readings at least every 2 hours.

Then share the curve with us so we can provide some input.

I am sorry your vet is at a loss. This just takes a little time and patience and the ability to tolerate a little higher blood sugar for a couple of days. Once we see a good curve after a stable regimen for a few days, we can figure out whether snacks would be helpful. First we need to know what his regular food and insulin are doing together.

Hope that makes sense!

Natalie
________________________

Blue
min-pin male 10 years old weighs 14 lbs.
home cooked food...venison and green veggies with brown rice and egg.

On vetsulin for 3 yrs, was last at 5 units
January 12 changed to Humulin N, started at 2 units

Jan. 12 readings stayed in high 300's,

Jan 13 predinner 371 - gave 3.5 units.
3 hours after eating 321 - gave additional 1 unit.

Jan 14 predinner 365. gave 4.5 units in am
Gave 5 units p,
3 hours reading 251

Jan 15 5 units am
3 hours after shot reading was 326,
6 hours 270 - small piece of jerky
9 hours 275
5.5 units after pm feeding.
3.5 hours 370.

Jan 16 gave 5 units am.
3.5 hrs after shot 266
7 hrs 404
11 hrs 324
dinner gave 6 units
3 hrs later 295

Jan 17 gave 6 units
fasting of 276

3 hrs later 198
5 hours after injection was 98

6 hrs 328
9 hrs 485
pm premeal of 305

dinner, presumably 6 units
3 hrs after pm shot 350.
4 hrs after shot gave peanut butter and cracker.
highest was 503

Jan 18 fasting 276
gave 6 units am
5 hrs 98, gave peanut butter and cheese and chicken treat.
10 hrs post 315.
6 units after pm feeding tonight
3.5 hours 190

Let me know if I have the above straight. I pulled it out of four different messages.

[CarolW]

Re: need help!

Hi Blue,

I'm sorry your vet isn't more helpful. I share the concerns of those remarking on how fast the dose is going up. Blue's body needs time to adjust to the insulin. You wouldn't likely get a true reading for several days, for ONE particular dose change.

You're certainly right to be preventing hypoglycemia by feeding, but it's safer, I think, to prevent it by keeping the dose of insulin low enough to avoid it that way. Meantime, while you're getting Blue adjusted to the change in insulins, from Vetsulin to Humulin, if it were me and Kumbi, I woudnl't be worrying about readings over 300. Not unless they were ALL over 300, and/or well up into the 400s - and did NOT come down.

What I'm trying to say, I think, is, if you settle on one dose, and stay with that for several days (my vets prefer, a week at least) you're likely to find the numbers changing after a time. So, where today Blue might show you a 300 or more, say, at noon, three days from now, he might show you a 220 around that time, instead. (I'm just using those numbers as guessing-examples.)

Mon, 18 Jan 2010 21:21:43 (PST)

[CarolW]

Re: need help!

Haha; I fell asleep while writing to you, and finished when I woke up; meantime, Natalie posted to you; I just read what she wrote.

I REALLY like her suggestions. If it were me, I'd follow them! I'll look for your next report, and cheer you on!

Mon, 18 Jan 2010 21:34:46 (PST)

[blue]

Re: need help!

Just read your replies..I droped to 5 units this am even after fasting was 487.
at noon 5 hrs after injection it was 297, 10 hrs after injection 281. I gave him 5 units after feeding this pm. your replies are wonderful! best advise I've had. I will leave on 5 units and try and do as close to 2 hrs readings as possible Sat. or Sunday. I will keep you informed daily on his reading. Thank you sooo much for all your help.I live in small town with few vets and the one I use is totally swamped, I know he's doing the best he can do but this site has been a God send

[k9diabetes]

Re: need help!

Oh good! I'm looking forward to seeing Blue's curve.

Natalie

[CarolW]

Re: need help!

Keep up the good work, Blue! I know it takes a certain confidence to DROP the dose when numbers are running high! But already you're seeing some benefit.

I too will watch for your next curve.

Wed, 20 Jan 2010 03:43:59 (PST)

[blue]

Re: need help!

thank you so much for all your encourgement, i need it believe me. I totally
dont understand what I am doing to tell you the truth.I get really spazzed about these high readings. today his fasting was 320, 5 hr post inj 255 then 10 hr post inj 422. he really felt good today even playing some this morning!
you guys know how much love i have for him, just like you do your own. he has me wrapped around dew claw!haha

[k9diabetes]

Re: need help!

I know it's hard to do nothing but it will pay off with the information you will get from the curve.

Blood sugar naturally varies anyway so it's trends you have to look for. You can drive yourself crazy worrying about every individual blood sugar reading when it might just be one of those days where it's higher or lower just because and tomorrow it will drop back down.

Natalie