Ozzi is gone... August 15, 2010

[ozzi]

Ozzi's Glucose Curve

Ok, so yesterday I got Ozzi's blood from his elbow callous without a problem. This morning I did his fasting at 6am which was 555..ugh! I was unable to get blood at 8am despite 5 sticks because the fur absorbed it and I couldn't get it on the strip. I stopped, fed him and give him insulin. I'm thinking that I will do some shaving to get better access to the blood droplet. Should I forget about the curve today since I couldn't get an 8am reading and do it tomorrow? Or is there value in continuing today? Thanks for your thoughts.
Kevin

[CraigM]

Re: Ozzi's Glucose Curve

Shaving the spot will , of course, help. Have you heard about smearing a VERY LIGHT dab of Vaseline (petroleum jelly) around the spot you intend to "stick"? It causes the blood droplet to remain in a ball shape (usually).

Craig & Annie

[ozzi]

Re: Ozzi's Glucose Curve

Thanks Craig! I have NOT heard of that, and I will definitely try it. I'm not convinced Ozzi is going to love the shaving bit, but I'll give it a try as well...I think it's the Dalmatian in him that prevents his Australian Cattle Dog part to be fully expressed....LOL!! I did opt to scrap the curve for today since I was missing the 8am glucose (when I give him insulin and food), and will attempt it again tomorrow. I also figured shaving him will cause him stress that might throw off the true glucose values.
Fingers crossed for tomorrow,
Kevin

[ozzi]

Starting Over With Ozzi...Need Advice

I love Ozzi's vet, but she told us not to change anything in his diet, including treats, and we would adjust the insulin to his diet. I don't think this is the best way to approach his diabetes management. Ozzi's glucose yesterday two hours after insulin was 298. This morning, his fasting blood glucose was 555. He has been having increasing hind leg weakness over the past week. I need to make some changes. I called the vet, she's not in until Tuesday! In the past, I've spoken with the on-call vets about various issues, and they are reluctant to say anything beyond "keep things the same and check in with Dr. XXX on XXX when she's in."

So here's what I'm doing:

(1) After researching dog foods, I found Wilderness made by Blue Buffalo. It is a high protein, low carbohydrate, grain-free dog food. I'm on my way up to tax-free NH (due to cost) to purchase it in both the kibble and canned forms.

(2) NO MORE REGULAR TREATS. He will get chicken, green beans and reduced fat cheese (which he loves and has minimal carb).

(3) I plan to do spot checks prior to insulin and 5 hours after to make sure his sugar remains okay.

My Question: He is currently on 23 u of NPH twice/day. The vet started him initially on 15 u and he has been adjusted up since. Should I return to the 15 u or somewhere in between? I feel that changing his diet and continuing on 23u will be too much.

I appreciate your expertise and advice. I'll check back in a few hours!

Thanks,
Kevin

[k9diabetes]

Re: Starting Over With Ozzi...Need Advice

For most changes that could effect blood sugar, I like a 25% reduction in the dose. Usually a dog can have anywhere from 1/4 to 1/2 of the usual insulin dose without any food on board (like they refuse to eat or before surgery). That amount covers the basal insulin needs unrelated to food.

So typically cutting the insulin dose 25% is a pretty major change in insulin dose when you are making food changes. At 23 units, a pretty good approximation of 25% would be 6 units so I'd say go down to between 15 and 17 units.

As far as the leg problem goes... I have two thoughts that sort of contradict each other.

The darker thought is that degenerative myelopathy has come to my mind every time we have talked about Ozzie's neuropathy problem. I'm not extremely familiar with this issue so I don't know the fine points of diagnosing it. I only know that the prognosis, sooner or later, is quite poor so I hope that this is not what Ozzie is suffering from.

I will, however, pull up some links as they may be helpful.

http://neuro.vetmed.ufl.edu/neuro/DM_Web/DMofGS.htm

http://vetmedicine.about.com/cs/dogd...nmylopathy.htm

The other train of thought I had when reading your most recent post about how he would collapse and then walk with a limp for a while reminded me of something Chris experienced half a dozen times in his last two years.

Every once in a while out of the blue he would just collapse, writhing on the ground obviously in pain, and not be able to get up. If I could get him to lie still for awhile - quite a while, usually needing 15 or 20 minutes - he would then be able to get up but still seemed uncomfortable. After another four or five hours, he would be okay again.

We always assumed that he might have slipping discs or some kind of spasm in his back since it came and went so abruptly. He had x-rays and there were a handful of problem discs in his neck and over his hips with bone spurs on the end of them but no pinching of the spinal cord.

Chris' overall nerve function to his back though was mostly pretty normal. He had some arthritis and was slightly slow on one back foot but not enough to warrant a diagnosis of anything.

I have wondered about clots too blocking the signals... a dobie I know suffered a clot and completely lost function in his back half.

I do think a consult with a good neurologist would be helpful. He certainly seems to be suffering some kind of lack of nerve communication and the neurologist would have the best arsenal of tools for diagnosing exactly what it is and treating it.

Our dog saw a neurologist after he suffered a collapse that was very different from the back problem. The general vet saw him right away and saw signs of vestibular syndrome but they didn't entirely match that so he got us into the neurologist within an hour or two.

The neurologist did a lot of noninvasive tests to ferret out exactly what was and wasn't working and concluded that it was in the brain - either at TIA or a growth. We worked it as a TIA, putting him on blood thinner and doing a cardiac ultrasound to look for a clot in the heart.

Without the neurologist, I don't think we could have narrowed down the problem as much as we did.

Natalie

[k9diabetes]

Re: Starting Over With Ozzi...Need Advice

I have merged all your posts together. We like to keep to One Dog - One Thread so that any time a question is raised it is easy to go back and read the whole history all in one place.

We all are in the habit of checking any thread with new posts so it is easy to get our attention to a new question in the existing thread.

One thing I wish I could change is allowing individual users to change the subject of their threads. Unfortunately, this software does not allow that.

But if you want to have the subject of Ozzie's thread changed, just let me know either here in your thread or by PM or by email (k9diabetes@gmail.com) and I will change it for you!

Natalie

[peggy0]

Re: Starting Over With Ozzi...Need Advice

HI there. Just fyi, I use blue buffalo as well. I started with wilderness but it actually raised my dogs BGs. So it could go either way. I would cut 25% as well and see if you have to build back up. Then you will see if the Wilderness is making it go up or down. They make a new food now called longevity. Its white fish, oatmeal, no grain, no corn etc. If wilderness doesn't work out you may want to give it a try.

[ozzi]

Re: Starting Over With Ozzi...Need Advice

Thanks Peggy...I will definitely keep that in mind! I checked Ozzi's BG at 8pm tonight prior to feeding and giving insulin and it was 585. I'm really hoping that a dietary change to a low carb food will help his numbers, and am glad to have heard of your experience just in case. I'm going to be feeding him Blue Buffalo Wilderness kibble and canned and keep my fingers crossed! I'll also decrease his NPH from 23u to 17 u twice/day, and we'll see what happens. Thank you again for your input.
Kevin

[Margaret Boyle]

Re: Starting Over With Ozzi...Need Advice

Thanks Peggy...I will definitely keep that in mind! I checked Ozzi's BG at 8pm tonight prior to feeding and giving insulin and it was 585. I'm really hoping that a dietary change to a low carb food will help his numbers, and am glad to have heard of your experience just in case. I'm going to be feeding him Blue Buffalo Wilderness kibble and canned and keep my fingers crossed! I'll also decrease his NPH from 23u to 17 u twice/day, and we'll see what happens. Thank you again for your input.
Kevin

Hi Kevin,

What Peggy is telling you about the food will work for you.

I had to change Lucy's food last year I use Burns High Oats which is high in fibre, you can't get it in the USA and this did help Lucy's numbers.

Now I am having to add some protein as the fibre uses the insulin up quickly.
It is getting the right balance, Lucy does not go by the book when it comes to regulation.

You are doing really well I follow all the threads and you have been given a lot of good advice and tips.

Marg

[ozzi]

Re: Starting Over With Ozzi...Need Advice

Marg,

Thank you for your words of encouragement! Today's good news is that Ozzi's fasting blood sugar was 433 at 8am, down from yesterday's fasting of 555 at 6am. I realize it's just one reading, but it's one that is going in the right direction. Ozzi loves his new food, and seems to have adjusted to no treats since he is not begging for them. He always loved the reduced fat cheese, so he is fine with that. Why? I do not know...to me it's tasteless!! LOL This morning I decreased his NPH to 17 units, so we'll see how he does. Visually, he is more comfortable this morning, not panting and not antsy. He is however still drinking more than usual.

I also started looking into a neurologist for his neuropathy...he now has some "dragging" of his back paws when I take him on walks. I'm lucky to be in the Boston area because I have access to Tufts and Angell Memorial. I looked at both web sites and have chosen a neurologist at Angell Memorial based on her expertise and Ozzi's issues. I'm going to wait until Ozzi's sugars are in better control, to not confuse the issue, since his hind leg weakness increases with high blood sugars.

Thanks again for your help and interest,
Kevin

[Margaret Boyle]

Re: Starting Over With Ozzi...Need Advice

Marg,

Thank you for your words of encouragement! Today's good news is that Ozzi's fasting blood sugar was 433 at 8am, down from yesterday's fasting of 555 at 6am. I realize it's just one reading, but it's one that is going in the right direction. Ozzi loves his new food, and seems to have adjusted to no treats since he is not begging for them. He always loved the reduced fat cheese, so he is fine with that. Why? I do not know...to me it's tasteless!! LOL This morning I decreased his NPH to 17 units, so we'll see how he does. Visually, he is more comfortable this morning, not panting and not antsy. He is however still drinking more than usual.

I also started looking into a neurologist for his neuropathy...he now has some "dragging" of his back paws when I take him on walks. I'm lucky to be in the Boston area because I have access to Tufts and Angell Memorial. I looked at both web sites and have chosen a neurologist at Angell Memorial based on her expertise and Ozzi's issues. I'm going to wait until Ozzi's sugars are in better control, to not confuse the issue, since his hind leg weakness increases with high blood sugars.

Thanks again for your help and interest,
Kevin

Kevin,

Glad Ozzi is feeling a bit better

Yes I agree with you get his blood sugars down a bit, then have your visit with the neurologist.
All the very best

Marg

[ozzi]

Re: Starting Over With Ozzi...Need Advice



Hi everyone!

We've had a busy few days changing foods, starting to readjust Ozzi's insulin, and taking lots of blood sugars!

I posted his glucose curve above, as well as some numbers from spot checks the previous day, this morning's fasting sugar, and our current plan of action.

We decided on changing his food to BB Wilderness on the evening of 3/6/10 because his spot checks were running high on his previous food and 23 u NPH, and he was becoming very symptomatic...increased drinking and urinating and progressively becoming more antsy. Since we made dietary changes, we decreased his insulin about 25% and planned to give him 17 units twice/day. After the first dose, his sugars were very high and symptoms increased even more, so that evening we increased it to 19 units. I was up with him all night, watching him deteriorate in front of my eyes. I was taking him out every 15 minutes or so to urinate. I was worried about DKA, so I watched his ketones, and each reading was thankfully negative.

Given the difficult night and his fasting BG of 464 the next morning, I decided to increase him, and debated between 21 and 23 units. For good or bad, I did go for 23 units, knowing I would be home monitoring him all day. In retrospect, I realize that I increased him too much too quickly, and tried to compensate by giving him only 14 units last night.

This morning's FBS was 357, so I feel better about that compared to previous ones in the high 400's and 500's. So my plan now is to try adjusting him by giving him 19 units twice/day for the next four days, and making a further evaluation on Saturday.

I'm wondering what people think, and if that seems reasonable. Also, I wondered if anyone had thoughts on his curve done yesterday....it looks like he plateaued about 12:30pm, and had a second insulin peak at 3:30pm. I was surprised to see that, and wondered if others have seen it. I'm not concerned about it, and just want to know if I should be!! LOL

Thanks again,
Kevin

[ozzi]

Re: Starting Over With Ozzi...Need Advice

Here is Ozzi's glucose curve. Please see my previous post just before this one for the questions I was wondering about.
Thanks,
Kevin

[Patty]

Re: Starting Over With Ozzi...Need Advice

Hey Kevin,
It says the image has been deleted on flickr. Can you reload it?
Patty

[CarolW]

Re: Starting Over With Ozzi...Need Advice

Hi Kevin,

How puzzling about the glucose curve data disappearing!

I have an idea for you. Do you have a plain text editor? NotePad, or something like that?

You could type the numbers into that, like this;

Time - Reading
(repeat)

don't forget to show when you gave food and insulin. Here's an example - from my Master Text file on Kumbi, where I keep all his numbers.

READINGS AND EVENTS

06:30 - 16.9 mmol/L = 305 mg/dL
Breakfast: 06:34 1 cup MFF dry, 1 tsp yogurt; 1 tsp MFF canned
Food lure, 07:00: 1 tsp MFF canned
07:01 - 23.6 mmol/L = 425 mg/dL
Insulin - 07:01 - 7.5 iu of Novolin-NPH
Finish breakfast - 07:01 - 3 tbsp MFF canned
09:00 - 20.7 mmol/L = 373 mg/dL
Treat, 09:04: - 1/2 tsp. MFF canned
Walk - 09:55 - 10:30 (35 min) moderate pace, moderate excitement
Three kibbles on return from walk
11:00 - 13.3 mmol/L = 240 mg/dL
Treat - 11:04 - 1/2 tsp MFF canned.
13:01 - 14.1 mmol/L = 264 mg/dL

These are merely typed text! Should be possible to post anywhere - except maybe not on Flickr, which might expect a .JPG!

Well, you could make a screen shot of the typed stuff, but why bother!

I'd be really interested to see Ozzi's curve.

Tue, 9 Mar 2010 07:35:57 (PST)