Improving regulation through diet based on curves

[k9diabetes]

Since his blood sugar went low, his insulin dose should be reduced a little bit. Even half a unit can make a big difference.

Variations in blood sugar are normal so it may not work to stay at a dose that gets his blood sugar down to 128 because some days instead of 128 it will be 57. With a dog who is not very consistent, in order to worry a lot less, you have to let their blood sugar run a little higher by reducing the insulin dose a little.

Although it's tempting to respond to higher blood sugar with more insulin, you actually can't base the insulin dose on high numbers. You have to take into consideration how low it's going and that determines the insulin amount you can safely give.

Sometimes we see dogs who have a huge difference between their highest and lowest blood sugar values - they might start at 425, drop to 80, and then go back up to 400 in 12 hours. And one would be really really tempted to increase the dog's insulin to bring those readings in the 300s and 400s down. But if the insulin is increased, it isn't just the 400 level readings that fall. The reading of 80 falls too - putting the dog at risky of hypogycemia.

So in a case like that, you have to look for ways to flatten out the curve because you can't increase the insulin.

You want to find a place where there is leeway for the "low days" that just happen as a natural part of diabetes.

Natalie

[k9diabetes]

Re: Pat's Bailey - newly diagnosed

Fortunately, dogs tolerate some higher blood sugars pretty well. You don't have to give them perfect blood sugar for them to have a long healthy happy life.

I always envied the dogs who got flat, thoroughly predictable blood sugar and have learned over the years that they are fairly rare. A little bouncing around seems to be pretty common.

There are various ways to tweak things a bit - you can change calories, for example, in a more finely tuned way often than you do with insulin dosage in small dogs.

One nice thing about Bailey's dose is that it's fairly large so you do have room to make small percentage adjustments but in small doses it's really difficult to make tiny adjustments in insulin whereas half a teaspon more or less food can do the job.

If a curve shows a big difference between highest and lowest blood sugar like the example I gave earlier, changing the content of meals or the timing of them can help flatten things out. It sounds like that is something that might benefit Bailey since his blood sugar varied from 267 to 32.

Anything that might help flatten out that variance would allow you to give Bailey tighter regulation of his blood sugar.

How you change the content depends on things like when the low blood sugar is occurring. If it occurs within 2 hours of injecting, you can increase carbs. If it occurs after 6 or 7 hours, sometimes adding fiber or protein will extend the time for the food's digestion. Or a mid-day meal can be given if your schedule allows. Those changes would be aimed to "feed" the insulin at whatever point the blood sugar is lowest.

So a good curve can help guide ideas for ways to change how his food and insulin balance to improve his regulation.

As far as why he's going low, could be he has finally become more sensitive to the insulin after a few weeks of more normal levels. Seasons can also change how much they need, whether through temperatures changes or changes in activity level. I agree that a lot of times why doesn't really matter.

Natalie

[k9diabetes]

Re: Pat's Bailey - newly diagnosed

You may be able to get the blood sugar you have wanted if the curve can be tweaked a bit. The thing to do is to get a full curve as a baseline for generally how his blood sugar "operates" - when it's highest, when it's lowest, how much the difference between highest and lowest is.

I don't know if you've read the page at the main site about the "race" between food and insulin...

http://www.k9diabetes.com/insulinfood.html

Any time you have a curve with very steep drops and rises in blood sugar, the food and insulin aren't well balanced. Carbs tend to get digested quickly. Fat and protein more slowly. And fiber can sometimes slow digestion of the food and absorption of the glucose it produces.

There is a lot of trial and error as dogs are notoriously unique in how they do things.

But the general concept is that a sharp drop in blood sugar during the first couple of hours means a lot of insulin is being absorbed but the food is lagging behind. So you add carbs, which usually are digested quickly, to help the food catch up to the insulin. Things like white rice or even crackers or bread if the drop is really quick.

If there is a sharp drop much later in the day, like 6-7 hours, then the insulin is taking a long time to be fully absorbed, much longer than it takes to digest the meal. Sometimes adding fiber or protein is enough to get rid of a sharp drop at that time. Sometimes the only way to do it is a third meal given when the blood sugar is on the way down because no matter what you feed it will be digested before the insulin gets going. You are aiming to "feed" some late strong insulin action.

Since about one-third to one-half of an insulin dose goes to basal needs unrelated to the meal, only two-thirds to one-half is related to how much is fed. So if you're feeding half a cup of food and giving only 2 units of insulin, you can do a finer adjustment by changing the quantity of food given slightly than you can by cutting even one quarter of a unit of insulin.

That can work the opposite way too. We have seen a few dogs who needed more calories and just a small amount of extra food threw off their previously really good regulation!

As I said, with Bailey at 22 units, you can do pretty fine adjustments to the dose. Half a unit to a full unit is a small change.

But changing the shape of the curve to flatten it must be done by changing the content or timing of the meal.

It all starts with a good, detailed curve, preferably for at least 18 hours with readings starting just before breakfast and insulin and at least every 2 hours after that into the evening. With that data, you can tell if there are problems with the curve and how to try to fix them.

Natalie