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Dr. Andy
Dr. Andy, Medical Director
Category: Dog
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Experience:  UC Davis Graduate, Interests: Dermatology, Internal Medicine, Pain Management
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Do you know what it could mean if the blood glucose level is

Resolved Question:

Do you know what it could mean if the blood glucose level is staying high even when insulin dose is increased?
Submitted: 11 months ago.
Category: Dog
Expert:  Dr. Andy replied 11 months ago.
Hello again,

Well, a couple of things

1. Possible insulin resistance. Some pets simply do not respond to certain types of insulin. So, you may increase the dose, and not a whole lot of anything occurs. This can occur with multiple insulin types especially in really obese pets.

2. Somogyi effect. This is when the insulin dose is actually too high.
What?
Yes. What happens is you give insulin dose too high. Drops the blood sugar to low 30's or lower. The body reacts and as a protective mechanism shoots the blood sugar really high. If not doing proper blood sugar curves, the vet or owner misses the fact that the blood sugar was tanking, and only sees the high values. So, what do they do? Raise the insulin even more, which is the wrong thing to do. This is the Somogyi effect.

3. Incorrect administration. It happens.
Insulin wasn't kept in fridge. Bottle was shaken really hard damaging insulin molecules. Not being injected correctly. All of which translates into the pet is not getting the amount of insulin you think it is getting.

4. A concurrent illness. So, like we were discussing earlier, Cushing's disease can do funny things with insulin dose requirements, as well as, if any other liver/kidney issues.

Those are some common causes for persistent elevations in blood sugar.
Hope that info helps.
Dr. Andy
Customer: replied 11 months ago.

How would you diagnose #2? lower the dose and see if the blood sugar is lower?

Expert:  Dr. Andy replied 11 months ago.
No dose change.

You simply do really good blood sugar curves. So, a good curve:
1. Early morning, before insulin and food you take blood sugar.
2. Give food then insulin after
3. Measure blood sugar every 2 hours until when you feed and give insulin again.
If blood sugars are dropping really low throughout middle of day, your vet needs to know.

Not always perfect curve. sometimes, you have to do a curve twice or three times to illustrate if there is an issue with low blood sugars.

Dr. Andy
Customer: replied 11 months ago.

I might have already asked this...sorry if I did and missed your reply...VERY stressed out over this. :S My dog has Cushing's which probably led to diabetes. Vet wanted to get blood sugar under control before starting his Cushings meds... But Im wondering if his blood sugar is not responding very well bc he still has all that cortisol etc from the Cushings. Is that possible? I think he was going to have him start the Cushings med soon anyway since we have some data... and Id love to see him start looking more like himself... How much does stress really affect a reading? About the only time I see him shaking/stressed is at the vet and when Im trying to poke his ear for a blood sample here at home...

Expert:  Dr. Andy replied 11 months ago.
Possible? Maybe, but should be at least showing improved blood sugar numbers while on insulin.

Vets approach is very reasonable. But, if things are not working out, I would ask the vet about simply starting some therapy for the Cushing's, either with Trilostane or Lysodren.

Stress can affect some readings a lot. For example, I can have pets measure over 200 just due to stress.

Stress should be less of a factor with at home measurements.

Dr. Andy
Dr. Andy, Medical Director
Category: Dog
Satisfied Customers: 28554
Experience: UC Davis Graduate, Interests: Dermatology, Internal Medicine, Pain Management
Dr. Andy and 5 other Dog Specialists are ready to help you
Customer: replied 11 months ago.

What percentage of the time would you say Cushing's along with diabetes is manageable?

Expert:  Dr. Andy replied 11 months ago.
Honestly. No clue.
With a internal medicine specialist guiding you, I would think easily 70%, as a educated guess.

Dr. Andy
Expert:  Dr. Andy replied 11 months ago.
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Andy

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