My Baby Boy Greyson!

[k9diabetes]

Re: Greyson - Now I'm only intermittently mildly terrified!

Brittany,

I want to go back through your thread before I respond. Kathy has given you some good advice already. Vetsulin might make partial adjustments easier and it could give Greyson a different profile.

Whether it might be able to help the periodic low days depends on if he's going low some days because his absorption of the insulin varies or because his body's need for insulin wobbles.

More tomorrow,

Natalie

[k9diabetes]

Re: Greyson - Now I'm only intermittently mildly terrified!

Brittany,

I couldn't find any record of one in your thread... has Greyson ever had a curve done at the vet since reaching his current dosage and food?

If not, then there's not much I can say about how he is doing on NPH. It could be that there is a big difference between his highest and lowest blood sugar or he could have moderately high blood sugar all of the time.

The one advantage of Vetsulin is the weaker solution, as Kathy mentioned, which would allow you to dose it in small increments. If you put the Vetsulin in a U100 syringe, you could make pretty small dose adjustments because you have to multiply the number of units you want to give by 2.5 to know where to fill the U100 syringe.

So if you want to give 4.00 units, you will the U100 syringe to 10. If you fill the syringe to 10.5, you would be giving 4.2 units of Vetsulin. Halfway between 10 and 10.5 on a syringe with half unit marks would give 4.1 units of Vetsulin.

Like I said before, whether those low days would go away with Vetsulin depends on what causes them. It seems to me, from observing over the years, that some dogs just wobble - probably their cortisol and other hormones vary, which has a direct effect on how much insulin they need. If that's the case with Greyson, no insulin will solve that problem.

However, if he sometimes absorbs the insulin faster than other days, a different type of insulin preparation might give him a better response.

He really needs a curve.

Is the vet willing to do one?

Natalie

[brittanyt]

Re: Greyson - Now I'm only intermittently mildly terrified!

i'm a little hopeful now.

the other day i left greyson all day for a curve. she said he never went above 200 (i should probably get a copy so i can get exact numbers) so she was confused as to why he isn't regulated or close to it yet. the only thing i could come up with that could have influenced it is that i was not waiting a full 12 hours between first and second injections. i remember hearing that you could feed/inject 2 hours early and it would be fine. apparently for greyson it wasn't. she told me to stick to a full 12 hours in between shots and see how he does.

i'm on day 2 of that. we will see if this helps anything. as for his eyes, he does in fact have cataracts in both eyes but she said they don't look nearly as bad as she thought they would. he still has vision in both eyes. i got a referral to the dr. that does the surgery but he will usually not do it until regulation has been reached.

i am sticking with the nph for now (thanks kathy and natalie for the input on the vetsulin) because the vet said he really seemed to be responding well to the nph and it could have just been that i was giving him his 2nd injection too early. can you see how that would interfere with regulation?

[We Hope]

Re: Greyson - Now I'm only intermittently mildly terrified!

Brittany,

The usual rule is that you can be up to an hour early or late without any problems. When we do time changes in spring and fall, many people don't adjust the insulin to correspond to that (meaning in spring they give the shot after 11 hours have passed and in fall, when 13 have passed).

With Greyson possibly getting insulin at times when only 10 hours have passed and then once again when 14 have passed, it stands to reason that there could be times where he had too much insulin to cause lows or not enough, causing highs.

Since you don't test at home, we don't know if Greyson stresses when all day at the vet and whether he tends to go lower from stress or not; some react by going higher while others go lower--it depends on the dog.

Not going with a 12 hour schedule might have been the problem.

Kathy

[k9diabetes]

Re: Greyson - Now I'm only intermittently mildly terrified!

Even though you "can" adjust an hour one way or the other doesn't mean it's an ideal situation so not something to do routinely unless something in the curve or an other-life commitment forces you to do it.

Usually, you save that one-hour window for emergency situations where you just can't get home to do the usual 12-hour shot.

That's really really good news about the curve though!!

Now that you're sticking to the 12-hour schedule, if you still see some high urine tests, I would consider the possibility that some days he might be going too low given his near normal blood sugar at the vet's, causing rebound, and reduce his insulin dose slightly.

I'm glad he had a curve done - please do ask them for the results and post them. I'd love to see them.

Natalie

[brittanyt]

Re: Greyson - Now I'm only intermittently mildly terrified!

okay, he's done it again. *every* time, after sticking with one dose for a week, on day 7 without fail he goes negative on the strip. it will be +3 for a few days and then on day 7 everytime negative.

i've read about the rebound thing (i forgot the name, starts with an S and it's something effect) does it sound like this is what's happening?

if this is happening, what would you suggest i do as far as dosage adjustment? he had 4.5 units yesterday so i gave him 3.5 today. (i followed my chart)

i did notice that the past few days before today's negative that it was pretty slow to turn +3. i was just under the assumption that it should be more like a gradual decrease on the strip (4,3,2,1,trace) but maybe not.

i know urine testing is not a great way to adjust dosages but it's all i have right now. i'm about to buy a glucometer though.

any input is always greatly appreciated.

[We Hope]

Re: Greyson - Now I'm only intermittently mildly terrified!

It sounds like you're only testing once a day. If you start testing urine three times a day, you might be able to see if Greyson does this daily or not. If it's rebound you can't really spot it by testing once a day--with either urine or blood.

http://www.vetsulin.com/vet/Monitoring_Urine.aspx

Have pet owner test urine three times a day: before the first meal (test 1), before the second meal (test 2), and late in the evening (test 3).

Refer to the following table: (table is at the link)

The table helps you interpret the results you get from testing three times a day and if there's a problem, what it might be.

If there is a Somogyi rebound, the only way to break the cycle is by less insulin. Too much insulin causes the lows and it's those lows that in turn create the highs--getting rid of the lows means also getting rid of the highs.

Would try testing Greyson 3 times a day and seeing what type of patterns you get--negative, positive (and by how much); even though you're not doing blood testing, it would give you a lot better idea of what's happening with Greyson and his insulin than a once a day test of either urine or blood would.

Kathy

[brittanyt]

Re: Greyson - Now I'm only intermittently mildly terrified!

kathy-
thank you so much. i started doing the 3x a day testing. Well, i've only tested twice and his 3rd will be later on tonight after his injection.

test one - negative
test two - (taken about an hour before he's due for his 2nd injection) +4 and was super quick to turn very high.

i didn't see an option on the chart for negative, then positive. should i just treat negative the same as trace? i wouldn't think so but since there isn't a listing for negative for first testing, that's all i can think to go by.

i only decreased his dosage by one unit this morning so i find it very strange that he was negative this morning and super high +4 tonight.

does it sound more like his lows (negative readings after a week of one dosage) are caused from too low of an insulin dose instead of too much? that's the only thing i can conclude from urine testing today. hope this is making sense. i'm not very good at explaining things..lol

i'll test again a few hours after his evening injection.

thanks again for directing me to that chart. i think it is going to be very helpful once i figure out if i can treat "negative" as "trace"

talk to you soon.

It sounds like you're only testing once a day. If you start testing urine three times a day, you might be able to see if Greyson does this daily or not. If it's rebound you can't really spot it by testing once a day--with either urine or blood.

http://www.vetsulin.com/vet/Monitoring_Urine.aspx

Have pet owner test urine three times a day: before the first meal (test 1), before the second meal (test 2), and late in the evening (test 3).

Refer to the following table: (table is at the link)

The table helps you interpret the results you get from testing three times a day and if there's a problem, what it might be.

If there is a Somogyi rebound, the only way to break the cycle is by less insulin. Too much insulin causes the lows and it's those lows that in turn create the highs--getting rid of the lows means also getting rid of the highs.

Would try testing Greyson 3 times a day and seeing what type of patterns you get--negative, positive (and by how much); even though you're not doing blood testing, it would give you a lot better idea of what's happening with Greyson and his insulin than a once a day test of either urine or blood would.

Kathy

[brittanyt]

Re: Greyson - Now I'm only intermittently mildly terrified!

my last post was probably confusing b/c i didn't clarify something.

on the chart, if you can go look at all the options, you will see that there seems to be many different scenarios to choose from. however mine looks like this so far :

test one - test two + test three tbd

the *only* positive + in the middle was when the first testing was also positive.

this is what is confusing me. seems weird he would be so low and then so high at only the second urine test.

maybe he really wasn't negative this morning. could it be that he was so high that a rebound was occuring causing it to show negative?? his drinking/urinating is completely normal so that's what makes me hesitant to think that's what is going on b/c when he is high, he aaaaalllllways drinks way more and has to potty quite a bit.

sorry for the novel. i just wanted to clarify b/c i went back to look at the chart again. i'm needing to see what: - , + means for first and second testing.

tia!

[We Hope]

Re: Greyson - Now I'm only intermittently mildly terrified!

Brittany,

When you get a negative on a urine test, it says that the bg's did not go up to 180 mg/dl or more and stay there for enough time to let the glucose spill into the urine. So you know Greyson was somewhere under 180 betwen your last test and the latest negative one. And this is one of the "minuses" about testing urine because while it can tell you there weren't any episodes of high bg's, it can't tell you if the bg's are in a good range or if they are too low and there might be a rebound or hypo problem.

There are two possibilities for Greyson to be able to go from negative into a high urine test range. One is using the insulin too quickly and I don't think this is Greyson's problem--that he's using up his NPH before he's due for his next shot.

The other is that his insulin dose is too high and this is rebound. Since testing urine doesn't let you see just how much under 180 Greyson is to produce the negative urine test, it's very possible that he is low enough to trigger a Somogyi Rebound and this is what sends his bg's soaring by the next urine test.

This is based on blood, not urine test results, but it sounds like what's happening with Greyson:

http://www.vetsulin.com/vet/Monitoring_Somogyi.aspx

"An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycemia. This is produced because blood glucose concentrations fall too rapidly. The moment that the Somogyi effect is triggered is very individual – it is a life-saving response.



Again, this is a graph of a hypothetical bg curve; you can see how the bg's go down, hit the low that triggers the body to think it's in danger and it then sends out counter-regulatory hormones to automatically raise the body's bg's. This is why you see the fast and high rise to them in the graphic.

In order to be low enough to trigger rebound, you don't have to have a real, treatable low/hypo incident, where you need to give syrup and food. There may be little to no sign from Greyson that his bg's have come down far enough to cause it. When we were first regulating Lucky on the old Lilly insulin, he went down to 35--the only sign we had of it outside of the actual test reading was that the whites of his eyes were bloodshot and the tone of the red was a darkish, maroon type. (He showed high bg's by having bloodshot whites of the eyes, but the red tone was a a brighter red.)

Some vets instruct their clients who test urine only that they should be seeing a trace, not negative, urine reading. Getting the trace reading is "confirmation" that the bg's are not too low. I'd take a trace to be in the same category as a negative for the purposes of trying to follow the urine testing chart.

Here's how urine test strips work. Until the bg's go to 180 mg/dl or more and stay there for a while, no glucose spills into the urine, so anything under that would be a negative reading on the test because there's no glucose in the urine it can measure.

For now, I think your reducing Greyson's insulin was the right move while you continue monitoring him with the urine testing.

HTH!

Kathy

[brittanyt]

Re: Greyson - Now I'm only intermittently mildly terrified!

kathy-
that post was so helpful. i have a much better understanding of what is going on. i think he is definately rebounding. i only decreased one unit in the morning and one at night from the previous days dosage. should i have decreased more than that? i didn't see anything written on the sites that talk about the somogyi effect that say when this is suspected (after getting a negative on the strip after many highs) how much one should decrease the dose. he had 3.5 today (4.5 yesterday)

i wondering if he is +3 or +4 tomorrow if i should descrease him even more if it is in fact high due to the rebound. maybe i should try 3 units twice a day for several days to see how he does. does this sound like a good plan? or do you know how much of a decrease in insulin dosage is suggested if a rebound is suspected?

thanks so much. i really don't know what i'd do without all of you.

Brittany,

When you get a negative on a urine test, it says that the bg's did not go up to 180 mg/dl or more and stay there for enough time to let the glucose spill into the urine. So you know Greyson was somewhere under 180 betwen your last test and the latest negative one. And this is one of the "minuses" about testing urine because while it can tell you there weren't any episodes of high bg's, it can't tell you if the bg's are in a good range or if they are too low and there might be a rebound or hypo problem.

There are two possibilities for Greyson to be able to go from negative into a high urine test range. One is using the insulin too quickly and I don't think this is Greyson's problem--that he's using up his NPH before he's due for his next shot.

The other is that his insulin dose is too high and this is rebound. Since testing urine doesn't let you see just how much under 180 Greyson is to produce the negative urine test, it's very possible that he is low enough to trigger a Somogyi Rebound and this is what sends his bg's soaring by the next urine test.

This is based on blood, not urine test results, but it sounds like what's happening with Greyson:

http://www.vetsulin.com/vet/Monitoring_Somogyi.aspx

"An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycemia. This is produced because blood glucose concentrations fall too rapidly. The moment that the Somogyi effect is triggered is very individual – it is a life-saving response.



Again, this is a graph of a hypothetical bg curve; you can see how the bg's go down, hit the low that triggers the body to think it's in danger and it then sends out counter-regulatory hormones to automatically raise the body's bg's. This is why you see the fast and high rise to them in the graphic.

In order to be low enough to trigger rebound, you don't have to have a real, treatable low/hypo incident, where you need to give syrup and food. There may be little to no sign from Greyson that his bg's have come down far enough to cause it. When we were first regulating Lucky on the old Lilly insulin, he went down to 35--the only sign we had of it outside of the actual test reading was that the whites of his eyes were bloodshot and the tone of the red was a darkish, maroon type. (He showed high bg's by having bloodshot whites of the eyes, but the red tone was a a brighter red.)

Some vets instruct their clients who test urine only that they should be seeing a trace, not negative, urine reading. Getting the trace reading is "confirmation" that the bg's are not too low. I'd take a trace to be in the same category as a negative for the purposes of trying to follow the urine testing chart.

Here's how urine test strips work. Until the bg's go to 180 mg/dl or more and stay there for a while, no glucose spills into the urine, so anything under that would be a negative reading on the test because there's no glucose in the urine it can measure.

For now, I think your reducing Greyson's insulin was the right move while you continue monitoring him with the urine testing.

HTH!

Kathy

[We Hope]

Re: Greyson - Now I'm only intermittently mildly terrified!

Brittany,

They usually decrease the insulin between 30 and 50% when there's a low or rebound. With the 1 unit per dose decrease you started with Greyson today, you've cut his dose around 25%. I believe I'd try staying there unless you see reason to come down that half unit to 3 units.

When you decrease insulin because of a problem, what you want to do is stay with enough units so that nothing like very high bg's or possibly ketones get started, but decrease enough so that the problem you're trying to solve goes away.

HTH!

Kathy

[brittanyt]

Re: Greyson - Now I'm only intermittently mildly terrified!

i have an appetite [or lack thereof] question. greyson has never been a morning eater. it takes quite a bit of coaxing and more time for him to finish his meal in the morning.

at night, i can put the plate down and he scarfs it down in less than 2 minutes. last night, i was lucky to get maybe 3 or 4 bites in him. he turned his nose up at it. we feed him ground sirloin, brown rice, and green beans. he used to love it. i thought maybe it was just an off night. i gave him 1 unit.

he did the same this morning. again tonight. i'm so frustrated b/c i thought i had finally found a food that worked.

what different things can cause not wanting to eat anymore? he seems okay as far as still being playful. he's sleeping a lot more but he is also playing with his chew toys too.

could worsening cateracts cause him to not want to eat or could this be as simple as he may just be burnt out or tired of that homecooked food?? i tried mixing up some beef baby food with wellness core kibble (his old food) to see if he would eat something different. he ate all of the baby food but left all of the dry. he also ate a little plain cottage cheese tonight. i don't know why all of a sudden he just doesn't want to eat. you would think he'd be starving after almost a day and a half and hardly any food.

mornings are always an issue but for him to refuse to eat tonight for the 2nd night in a row worries me. he always scarfs his meal at night.

is it a good sign that he is eating something rather than nothing at all?

i went and looked at some homecooked recipes to get more ideas for variation and i saw where one lady used a little italian dressing mixed in. i coated his meat, rice , and veggies with that thinking the smell would get him to eat but that didn't work. i'm not doing that again b/c i read that there was onion and garlic in the dressing. do you think i hurt him?

sorry for all of the questions. i'm so worried. does it sound more like he is just turned off by his normal meal and i need to come up with something different? have any of you had yours just all of a sudden stop liking something? the fact that he will eat some things makes me feel like it might not be a health issue.

any input is always appreciated. thanks

brittany

[We Hope]

Re: Greyson - Now I'm only intermittently mildly terrified!

Brittany,

You were very right in that you didn't give Greyson a full dose of insulin when he didn't eat much. It's good that he's eating what he likes, though.

What's happening with Greyson's bg's? Reason I ask is that sometimes there can be problems with eating when they are either too high or too low.

If not eating a full meal continues much longer, I would take him in to your vet to see if there's something else happening with him, like possibly a UTI.

HTH!

Kathy

[k9diabetes]

Re: Greyson - Now I'm only intermittently mildly terrified!

Before he was diabetic, would he start to refuse something he used to like?

If so, that may be all it is.

If not, then I'd consider that something is bothering him - high blood sugar, pancreatitis, UTI... refusing to eat is usually a sign that something is wrong. Unfortunately it doesn't tell you WHAT is wrong.

But with a picky eater like Greyson or Robert's Mik it's a tougher call. So maybe your knowledge of him in the past can help sort it out.

I agree that if he still refuses to eat tomorrow that you should have the vet take a look. I always take refusing to eat seriously in a dog who usually eats well, as Greyson has at dinner time. I just wish it told you more about what is bothering him...

Natalie