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One of the first things that I think of when a diabetic dog has a consistent blood sugar that is too high is that the insulin may be bad. I know this may sound basic so please don't be offended but I want to review proper handling of insulin with you before moving on to the more complicated stuff. I find it helps to start at the beginning so that we don't make things more complicated than they need to be. Is that OK?
Thank you for getting back to me about that. It sounds like the insulin storage and handling is appropriate which is good. I just want to make sure that you are rolling the insulin and not shaking it. But, now that part is done we can move on to other reasons for high blood sugar in diabetics. Different insulins have different dosing so you can't necessarily say that one unit of vetsulin is the same as one unit of the humulin. It sounds like his insulin needs have changed and the key is to find out why and treat the underlying cause. Things that can increase insulin needs include bushings disease, infection (typically a bladder or kidney infection due to the blood in the urine), additional snacks throughout the day that were not previously part of her diet, other hormones (is she spayed?), etc. Once that is ruled out, you have to look for what is called a symogi effect. This happens when the blood sugar drops too low causing counter regulatory hormones to be released in large quantity resulting in a spike in blood sugar. Testing for this requires a serial blood glucose curve. This is performed by monitoring glucose every 1-2 hours throughout the day (usually a 12 hour period but can also be a 24 hour period) to look for the peak and trough glucose levels. Here at my hospital, we are 24 hours so we can perform a 24 hour glucose curve to get a complete picture of what is happening over time. If we can identify a symogi effect, the insulin dose can be adjusted to prevent such a drastic drop and the tendency of the body to make a drastic correction. Because management of diabetes can be complicated, some people choose to see an internal medicine specialist until the insulin dose is stable then follow up with their general practitioner from there. Since you are seemingly having issues after she did well for so long, it may be worth it to discuss the possibility of a referral to an internist with your general practitioner to trouble shoot the situation.
Without seeing what blood work was done, I cannot say that a complete work was performed however it sounds like it was more thorough than most. Have you ever had a blood glucose curve performed where the dog stays at the vet for the day or overnight and has blood sugar check hourly or every 2-4 hours throughout the day?
Different insulins wil have different dosages so 1 unit of her old insulin is not necessarily equivalent to 1 unit of the new insulin. Sometimes, dogs need an alternate dosing schedule such as once a day insulin or a lower second dose instead of the same dose twice daily. Unfortunately, there is a lot of guesswork that goes into getting a diabetic dog well regulated if they are not straightforward as it sounds like your dog is not. It sounds like your vet has done a good job so far, but it sounds like it may be time to get a specialist involved. An internal medicine specialist is trained in managing all sorts of chronic and complicated conditions such as diabetes mellitus and may be able to see what we are missing. Since your dog has had a thorough work up and is still difficult to regulate, there is clearly a piece we are missing. The other key with diabetic management is consistency and regimented routine. Eating at non-mealtimes can throw of fate blood sugar because there may not be enough insulin in the system to work on the new glucose that the liver will make from the nutrients in the food. The reason that we recommend giving animals insulin with meals is that under normal circumstances the pancreas would release insulin after eating to help the cells use the glucose made from the meal that was just eaten. when there is no glucose, the cells cannot use this glucose and the blood sugar becomes high. If you are giving your dog a snack without insulin on a regular basis this may be contributing to her increase in blood sugar. I recommend cutting out the snack and seeing if this helps keep her sugar more steady.