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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 33288
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My dog has recently been diagnosed with diabetes. She's a Westie,

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My dog has recently been diagnosed with diabetes. She's a Westie, weighs 7.5kg and is on 5u of caninsulin twice a day. She started on 3u but every week she goes in for her glucose curve, her numbers are higher so I'm told to increase 1u. 2 weeks ago her highest number was 20 something and went down to about 13, today she is in the high thirties! Our vet is confusedand told us to increase to 6u, a friend has mentioned something called rebound and to reduce to 1.5u twice a day. I don't know what to do or think.
My questions are:
Why might her insulins levels be increasing every week despite more insulin?
Could this be rebound?
What are the risks of rebound?

Aloha! You're speaking to Dr. Michael Salkin

Yes, when increasing doses of insulin are needed, rebound (the Somogyi effect) needs to be considered. This is evidenced when the blood sugar drops below 65 mg/dL (3.6 mmol/L) only to rebound over 400 mg/dL (22 mmol/L). Here's more on this effect:

This is why it's important not to judge how much insulin is required by looking at just one blood sugar daily; instead, a glucose curve - blood sugar levels taken every 2-4 hours for 12-24 hours is necessary and gives a more accurate assessment of how well the current insulin dose is working.

In general, a 15 kg (33 lb) dog is going to need more insulin than 5 units. I believe that Poppy is considerably underdosed at this time rather than the Somogyi effect being present. I would have initiated insulin dosing at 0.5 units/kg twice daily or 7-8 units twice daily.

Please respond with further questions or concerns if you wish.

Customer: replied 3 years ago.
She has had a glucose curve every week and that is why the increase. This weeks numbers are (uk numbers)
26.3 (fasting)
These numbers were taken every two hours.
She weighs only 7.5kg.
What reasons may there be for the continued increase? She has severe skin allergies but no other health issues.she has tested negative for pancreatitis.
She does get very stressed at the vets, but would it cause the continued increase?

Thank you. I don't know why I saw 15 kg instead of 7.5 kg. Mea culpa. I would have initiated insulin at 4-5 units. That curve simply indicates underdosing. She's a severe diabetic with those numbers. There's no evidence of rebound (Somogyi effect). I wouldn't investigate causes of insulin resistance or problems with administrating the insulin until she didn't respond to up to 12 units of insulin twice daily.

Please continue our conversation if you wish.

Customer: replied 3 years ago.
Ok thank you.
The vets mentioned stress during testing as a possible cause of high numbers. How does stress affect her Blood Glucose? Just trying to understand why the increase in numbers rather than a reduction - I would have expected to see some reduction instead of starting numbers (before insulin therapy) as between 23-13 (UK numbers) and within three weeks PLUS insulin seeing those figures today. Is this normal for newly diagnosed diabetics to have such a reaction/technical worsening if the condition?
Sorry to keep asking, I'm just so worried
Stress is always a consideration but we see stress-related hyperglycemia more commonly in cats than dogs. At such high numbers an increase or decrease of such an extent as noted in that curve simply indicates unregulation. In other words, there's little significance of movement in either direction when the numbers are so high. Yes, newly diagnosed diabetics are going to be more fractious when attempting to regulate them and severely diabetic patients are the most fractious of all. I understand your concern. Poppy's vet needs to be more aggressive at this time.
Customer: replied 3 years ago.
Well she does act like she thinks she's a cat ...
Just a few more questions if that's ok?
What are the dangers of her being so high? Is there anything in particular we should be watching out for? I know the danger signs of low blood sugar but not high.
Is there anything I can be doing extra to help?
Just be careful that you're following the rules of insulin administration as outlined by your vet. The most serious sequela of persistently severe hyperglycemia is diabetic ketoacidosis. This describes the state in which fats begin to be metabolized for energy because sugars can't be. The byproducts of such metabolism are called ketone bodies and acetone is one of those bodies. As you can imagine, acetone isn't something we want coursing through our bodies. These are very ill patients who need to be hospitalized with critical care.

Tell her she's not a cat. She has enough problems at this time.
Customer: replied 3 years ago.
Last question, she has seemed much brighter in herself this week, noticeably more energetic and active, eating better etc. she has just slept for weeks and appeared depressed and wobbly on her legs. Today she could jump in my car (she hasn't done this since before Christmas). I viewed this as a good sign, hence tonight's stress over higher numbers.
Why might she appear better but be worse?
(Btw, we talked, she understands she is in a fact a dog.)
I would have to review previous blood work to answer that. I assume that there were extenuating circumstances previously - perhaps her pancreas was inflamed. Remember, diabetes causes multi-system disorders - not just hyperglycemia and so we can't assume that her behavior will be directly related to her blood glucose level although it's certainly reasonable that she'll feel even better when we get that blood sugar down into the normal range.
Dr. Michael Salkin and other Dog Specialists are ready to help you
Thank you for your kind accept. I appreciate it.

I'm going to check back with you in a few weeks for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.

Please disregard the info request.