Kramer got his wings... March 18, 2010

[Patty]

Re: Kramers Story

Breanne,
I can't say whether something like Humalog is the way to go or not, but if you want some feedback from someone who's used it on their dog, Peggy has.

The two of you were the only ones I know of that had used Levemir. As far as I know she still uses Levemir and Humalog to cover the post prandial rise with Molly. You might contact her.

Patty

[We Hope]

Re: Kramers Story

http://k9diabetes.com/forum/showthre...=6712#post6712

You can also send Eileen a PM, as she recently switched to Humalog for Mildred.

Kathy

[eyelostit]

Re: Kramers Story

Whatever you decide Brea, know I'm thinking about you and Kramie.

[k9diabetes]

Re: Kramers Story

From your previous posts...

Kramer weighs 17lbs but is a large mini and his ideal weight is around 22lbs. We're trying desperately to put weight on him but obviously have to mind the cholesterol.

We feed him ground turkey, green beans, brown rice, white rice, chickpeas, and lentils. For supplements he gets milk thistle, samE, coQ10, fish oils, calcium citrate (he's prone to bladder stones), niacin, and a multi vitamin.

We've been giving the R with the N because when we give N it doesn't seem to affect him until 4 hours later so his BG would sky rocket and then come down. The R hits him around half an hour to an hour later and works good with the food.

Kramer has insulin duration problems. We give him N 3 times a day because of it.

At about hour 6 he is on a steady incline up and if we wait the whole 12 hours hes high for about 4-5 of it.

When we do R and N together you can actually see the R kick in, then the sugars come back up around hour 2.5 to 3 and then the N kicks in around the 4-5 hour mark and he steadily comes up at the 6th hour.

__________

Most likely, the huma/novolog would get moving faster but it will also quit faster so it would run out sooner than Regular currently is, leaving a larger gap until the NPH gets started...

So overlap isn't the problem really, at least not when you're giving N and R together before or with a meal.

Unless it acts slowly in Kramer, I don't think it's the solution to the problem you've described.

How strict are his diet choices?

Have you tried cutting out the white rice? Something that digestible and carb rich definitely could be burning through the insulin during the first few hours.

I imagine it would be difficult to find something to replace it with but maybe even just using more brown rice and no white rice might help.

Would lowfat cottage cheese be too fatty? I can buy 1.5% cottage cheese and I just find it worked really well to extend the digestion of Chris' meal. It's a complex food that did not digest quickly.

Can he have some fiber? You've probably already tried it but figure it's worth asking... seems like some fiber might be good for the fatty blood too.

If all his blood sugars are now high, you should be able to increase the insulin in general. If all his blood sugars aren't high, then aside from a tweak to the diet it might be reasonable to live with the spikes if they aren't too extreme or too extensive.

Sometimes I do think other matters are more important than ideal blood sugar control...

Can you give us an idea of what a typical day looks like now blood sugar wise - how low the lowest BG is, how high the highest is, how long each is lasting?

You never know until you try so it wouldn't hurt to try Huma/Novolog but my guess is it won't help with this particular problem... that it might reduce how high the BG goes in the first hour or two but then raise the BG at 3 hours higher than it is now.

Natalie

[KramiesSister]

Re: Kramers Story

We actually didn't have white rice in his diet at first. It was all brown rice, but he's usually so insulin sensitive that the insulin would kick in before the food even made his blood sugar rise, so we added the white rice to make up for that quick drop that he had.

This past weekend we made new food for him, added fish and more chick peas and decreased the turkey. What kind of fibre should we add?

In a normal 8 hour cycle Kramer's blood sugar can go as high as "HI" and as low as 108 at about hour 5-6. The reason I would like to use a rapid acting insulin at the meal is because I would ideally like to cut back on the N. When the N kicks in, it Kicks in Fast and drops him fast. And its not rebound thats causing all of the other highs because we have cut right back and worked up and it doesn't make a difference. Its his blood fats that are causing the problem right now.

We do give him about a tablespoon of low fat cottage cheese on each meal to try to put on some weight.

The spikes that we get right now are "down" spikes...his blood sugars are opposite of what we would like to see...its in the 400-600 range for most of the day with a down spike of about 200 once in a while. If we increase the insulin we increase the drop and just get rebound.

I think taking the white rice out is a good idea and I can't believe I didn't think of it sooner. Next time we make food...probably next weekend I will definitely make that change.

I've got a call in to the IMS today to see what her thoughts are on all of this.

Breanne and Kramer

[peggy0]

Re: Kramers Story

Barley is high in fiber and is in some of the perscription diabetic food, but I'm not sure if it would have the same affect as rice.

[We Hope]

Re: Kramers Story

http://www.walthamusa.com/articles/wf103fle.pdf

Long Term Management of the Diabetic Dog
Drs. Fleeman & Rand--University of Queensland

They start talking about fiber, high lipids and diabetes on page 3. They're suggesting low-glycemic index ones like barley, as Peggy said, oats, etc.

Kathy

[KramiesSister]

Re: Kramers Story

Adding fibre would probably be a really good idea. I'll look into that.

My only real problem with R is that I really feel as though it is a hinderance right now because my mom is using it as a quick fix whenever Kramer is high. She doesn't take into account that it lasts longer than an hour, so she'll just use it whenever because she's in a panic and then tries to deal with the after effects later. If she were only using it with the meals I wouldn't be quite so quick to look for an alternative. I tried talking her into increasing the R and decreasing the N, in hopes to get drop to co-incide better with the food. We don't need a big drop later in the "cycle" we need it earlier. We never used to have this problem!

Anyways, Thanks again for all of your suggestions, I really appreciate everything. I know that sometimes my mom and I can be about as difficult as Kramer is and I appreciate everyones patience.

Breanne and Kramer

[k9diabetes]

Re: Kramers Story

Hey Breanne,

I was cracking up at the idea that anyone needed patience with you! You've always been an incredible advocate for Kramie and thoroughly knowledgeable!!

Yeah, your mom's use of R definitely could get to be a problem! The timing could create a scary situation. Huma/Novolog might be the better choice if she just can't not give that correcting insulin, although the timing could still be bad.

This may be a time when you have to heave a sigh and learn to live with blood sugars that are far from what you would like. That's really really hard to do, I know. But giving R in response to a maybe feeling a little panicky about high blood sugar gets you into a cycle of chasing numbers and overlaps, not knowing what insulin is coming and what insulin is going, and massive swings in blood sugar up and down. Those aren't good for Kramer either.

I don't know if it's the same in dogs but a human diabetic has posted here that sharp swings in blood sugar feel really crummy too and they sure could get the body going into a nonstop cycle of stress.

I hope the diet changes help. Couldn't hurt to try. It's good to know that Kramer seems to feel well. In the end, that's what's really important in all this. I hope you and your mom can take some time to step back from your worries and have some fun with Kramer!

Natalie

[KramiesSister]

Re: Kramers Story

I talked to the IMS yesterday and we agreed that Humalog/novolog would be something to try. If it doesn't work we won't be any farther behind...he has high blood sugars regardless. We talked about rice and she says that with the way his blood sugars are right now we could even just take all rice right out and add some veggies like carrots and peas (they're still lower on the glycemic index than rice) and then just feed him a larger amount of food at each feeding.
We just made him a batch of food this past weekend so we are going to finish that stuff off and give this novolog a shot, and then when it comes to cooking day we'll re-evaluate, and most definitely take out the white rice, possibly even the brown too. At that time we would obviously have to recheck his insulin and make some changes.
I asked her about fiber but she said he's getting a lot of fibre from all of the vegetables that he's getting.

Yesterday the Novolog showed some promise, my mom gave Kramer 1 unit of Novolog and his normal amount of N, and an hour after food he had only gone up 20 from fasting as opposed to his usual 250 point climb. By hour 3 he was starting to go up again and I'm not sure what happened after that...I'm going assume that the N kicked in shortly thereafter...but thats just a guess because it was the middle of the night.

We'll see how it works out.

I wish that I could have some fun with Kramer! Its hard for me not living there full time. It seems as though every time I'm there my mom decides to make a big change in Kramers care and we spend my entire visit trying to hash things out. But any time I get to spend with him is alright with me! I think Kramer actually gets excited when my mom and I are both away...that way he just gets to have "man time" with my dad, without all of the excess poking.

Breanne and Kramer

[KramiesSister]

Re: Kramers Story

Hey All!

I have some fairly good news to report. After a month on cholesterol drugs and some major diet changes, Kramer is doing very well! (knock on wood).

His blood sugars are staying very low (with the exception of the odd curveball he throws us ever couple days to keep us on our feet). And we have humalog for those days when the meter says "hi" (he gets the humalog and his meal 10 mins later) and it really has been working like a charm. So well in fact that we are able to give him insulin on a 12 hour schedule again!

The major changes that we made with the help of the IMS were adding a prescription cholesterol drug and taking out all of the rice from his diet and replacing it with veggies such as carrots and peas (which are still lower on the glycemic index than rice).

He had bloodwork on Friday and they sent it away so we should be getting the results in the next few days...so heres hoping theres some improvement!! Thanks everyone for your help with all of this!

Breanne and Kramer

[We Hope]

Re: Kramers Story

Breanne,

I think Kramer's bg's have been a "sneak preview" to what the tests will show. Making the changes has made a big difference, diabetes-wise!

Kathy

[Patty]

Re: Kramers Story

Breanne,
It's so good to hear some good news on Kramer! Hoping the bloodwork comes back looking just as good.
Patty

[k9diabetes]

Re: Kramers Story

That is great news Breanne!! I'm so happy that the cholesterol drug seems to be working. Sounds like the cholesterol may have been playing into Kramer's diabetes troubles for a while.

I am not really familiar with the interaction between the two so I will have to try to read up on that.

Congratulations!!

Natalie

[KramiesSister]

Re: Kramers Story

Click Here for an article on hyperlipidemia.

We're not out of the woods yet...Kramer doesn't have cataracts, but he has major fatty deposits in his eyes, so much so that he can't see anymore. These can pose some risks, as is talked about in the article above... so we have to be careful, especially since we don't have a veterinary opthalmologist anywhere near us (the closest is 7 hours away).

I'm going to ask the IMS about it because thats about the only thing that seems to have gotten worse lately, and I'm concerned about any discomfort that he might have. But other than that, Kramer has been much more alert and playful (even with his sight so poor) and you'd never know he was 12 yrs old!

Breanne and Kramer