Sandy's Zoe - Sweet Zoe has passed on

[k9diabetes]

Hi Sandy,

This curve is looking much better. The Vetsulin appears to be lasting just about 12 hours, which is great.

This is a very typical curve with Vetsulin, lowest blood glucose a couple of hours after the meal - that's the 30% semilente insulin working.

Like quite a few dogs I've seen with Vetsulin, she's getting a pretty large difference between highest and lowest blood glucose, which does make it difficult to increase the insulin for better control.

I'd say you could raise the Vetsulin a small amount, especially if you start home testing blood glucose so you can monitor it closely. I'd be comfortable with the lowest number coming down to the low 100s.

But if this is as good as it gets, this is pretty good. The BG in the 300s is brief, only during about 4 hours a day. The rest of the day the blood glucose is high 100s and 200s.

The Cushings is well controlled so I don't think you have to worry about that being part of the blood glucose control.


4/23/08 Curve
9:30 318
11:30 168
1:30 218
3:30 228
5:30 340

4/24/08 BG at 11:30 216 (pre-cortisol injection)

ATCH Stim test: 1.2 and .9

One vet at the office, who says he consulted with 2 internal medicine specialists said this is probably the best we can do and with the 2 borderline hypoglycemic days, shouldn't increase the insulin. The other vet says he'd be comfortable going up to 14.5 or 15 units 2x a day. It seems to me like she's doing much better on the Vetsulin than the Humulin.

I have asked the vet multiple times about home BG testing and he really discouraged it. Says it is too difficult & painful for the dog and really not worth it. How do you do it? Does it cause the dog pain? I've checked my own BG (with my step dad's meter just for fun once after an "Oreo" challenge and it hurt!).

Nothing here is "borderline hypoglycemic"!!! It may be lower than they like to keep dogs because the blood sugar varies from day to day and it could go lower than the 168. BUT 168 is higher than normal blood glucose and hypoglycemic isn't a serious consideration until you get under 100. Hence I agree with the second vet that a slight increase would be worth trying.

Vets keep dogs in the 200s to avoid any risk of hypoglycemia from normal daily variation in blood glucose levels. With better monitoring via home testing, though, you can get a very thorough picture of her typical patterns and even potentially tweak the diet for a flatter curve, allowing you to bring her overall blood sugar down.

I encourage you to come to my site and forum! http://www.caninecushings.net/forums/images/smilies/smile.gif

We can help you get the best control possible and give you more insight on standard veterinary approaches and what more can be done.

I've been home testing Chris for years. We do a lip prick and there's a video of me testing him there here: www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html).

I know of other mini Schnauzers being tested on the lip. You can also use the base of the tail, the pad at the dew claw, and an elbow callous or wart. There are demonstrations of most of these techniques at the link above.

The forum is at www.k9diabetes.com/forum (http://www.k9diabetes.com/forum). You will recognize the style instantly as it runs on the same software as this one.

Dogs' lips have almost no nerve endings and Chris doesn't mind being tested there at all, as you will see from his somewhat bored expression in the video! http://www.caninecushings.net/forums/images/smilies/rolleyes.gif

I keep all of Chris' readings in a spreadsheet and do charts when I want to look at his blood glucose trends.

You may be able to add a small tweak to Zoe's diet that can help get rid of the large blood sugar swing... come on over to the forum so others can provide additional input. You'll see lots of familiar faces there!

I'm thrilled to see Zoe doing so much better and putting on weight. You're making great progress.

Best wishes,

Natalie and Chris http://www.caninecushings.net/forums/images/smilies/smile.gif

[k9diabetes]

About Zoe from the Cushings Board...


Hi there! This is my first time posting. I have a 8 1/2 year old mini schnauzer. We are almost at the 1 year anniversary of the diagnosis of diabetes. After several days of being hospitalized, the vet was able to get her blood sugar down (she started at above 500), and we had her pretty well managed for 6 months. She continued to lose weight slowly though. The vet attributed it to her diabetes and the diabetic dog food-- Purina DCO-- so I increased her food from 1/2 cup 2 times a day to 1 and 1/3 cup 2 times a day. She continued to lose weight, particularly muscle mass. At her peak she ws 27 lbs and she was just 20 lbs. by mid-January. In mid-January, after returning from 3 day trip she just didn't seem like herself. She vomited that night and the next day. Also she had been drinking excess water again and having accidents in the house. After a couple of trips to the vet it was determined her blood sugar was in the 500s again, despite the increased dosages of insulin. So, we increased the insulin again for several days and once out of crisis, the vet did a low dex supression test which he said supported his belief that she had cushings as well. Thereafter we started her on 50 mg of Trilostane 1 x per day. 10 days later of 2/1, we did an ATCH test and blood glucose curve, and ATCH results were 3.3, 2.2 and 3.1. We kept her on the same dose of trilostane. On 2/16 we did another ATCH test with results of 1.2 and .9. I was told because we were adjusing her insulin based on the trilostane dosage, we'd leave her at the same trilostane dosage even though the .9 was a bit low. We have struggled with regulating her blood sugar (she was hovering between 498-600 for weeks-- the humulin would literally vacate her system after 4 hours), and have switched from humulin-n to Vetsulin and she is on 14 units two times a day. I check her urine for glucose daily, and have had 3 days total since this all started with a single negative test; the rest are all in the 1%-2% range. Today, she had a curve done, and another ATCH test done. She also had a fructosamine test done. The curve looked better, ranging from a high of 348 to a low of 168, which is the best it has been in months. And she is up to 23.2 lbs. We don't have fructosamine results yet.

But, here's the question, (finally--sorry for being long winded but I want you to have all the facts), the vet tech at the vet's office accidentally started the ATCH test at 2 hours after she was given her trilostane, instead of starting at 4 -6 hours.

The vet says that if the results come back tomorrow on the "high" end, he'll re-test her tomorrow for free. However, if the test comes back normal, there will be no need to retest. What is the purpose of the 4-6 hour window for starting the test? And how would an early test affect the results?

My poor dog has been just starving lately. She's been barking at me both before and after meal times, which she has never done before. She's also been sleeping on the cool tiles more often than not. I don't know if I should insist on a re-test, much as I hate to subject my puppy to more visits to the vet.

Also, does anyone have any experience with Vetsulin? We switched at the end of February, and are going through tons of it.... 14 units 2 times a day for a 22 lb dog. I am literally running to the vets office every 2 weeks to get more, at $30 a vial. She's on purina DCO already and I was wondering if anyone has any suggestions about getting her blood sugar down a little less-expensively?

[We Hope]

Sandy,

Some of the diabetes portion of Zoe's story is familiar. When Lucky was diagnosed, he responded well to human insulin for one week--after that, it was like giving him no insulin at all. The next insulin we tried was beef, because it has a longer activity in both dogs and people than human insulin does. He responded to that just as he did to the human insulin. Shortly after an insulin shot, the best we could do was to get into about 300 range--within 3-4 hours after the shot, we were back into the 500-600 and possibly more range.

If I watched Lucky, I could see when he'd "burned out" the insulin--his coat would become dull and lifeless--and we'd get the results that he was high when I'd see that. Going to resistance level with them did nothing to control his bg's. During that time he was constantly hungry and hyperactive from literally having too much glucose in his blood. With all of this, he never had ketones--we're grateful, but no idea how he didn't.

Lucky got nowhere until we switched him to pork Lente insulin (at that time only Lilly had it in the US). He was also switched to canned W/D just before we started the new insulin. After being on W/D for 2 weeks and pork Lente insulin for one, Lucky had dropped 400 points, going into the mid 200's--a number we'd never been able to get from him before--so then it was a matter of tweaking from that point on.

Lucky's problem was immune-mediated insulin resistance; his body destroyed the "foreign" insulin just as it would a bacteria or virus. Later on, when Lilly discontinued their pork Lente insulin and we were forced to use their pork NPH for a bit, we discovered that his system was also not happy with the protamine suspension (a "foreign" protein) and different preservatives of that type of insulin. The only reason he had respectable bg's then was because the insulin itself was still pork. We contacted Intervet for assistance in filing with FDA for permission to import Caninsulin for his personal use; I believe he was the first US patient to start on Caninsulin/Vetsulin who was not in an earlier study.

With the U 100 Lilly pork Lente insulin, we could keep him in the 100 range, but with the U 40 Caninsulin/Vetsulin, you could test him 8-10 hours after breakfast and morning insulin and he would give you an 85--in normal bg range for a non diabetic dog or person. I don't see anything in Zoe's curve that I'd call borderline hypoglycemic. :)

The semilente part of Caninsulin/Vetsulin has a profile similar to R in that it goes to work quickly and doesn't last a long time--the ultralente part of it starts working slower and lasts much longer. Going back to earlier times, semilente insulin was available on its own as a fast-acting insulin; a lot of people used it to cover their meals just as they use R or an analog fast/rapid acting insulin to do that now.

What we found in the comparison of the two insulins--U 100 Lilly pork Lente and U 40 Caninsulin/Vetsulin--was that because Caninsulin/Vetsulin is more dilute, it starts working sooner than the stronger U 100 one (also doesn't last as long). This meant that it was working when Lucky's meals began to digest and the bg's start rising--it handled his post-meal spike better. We were also able to adjust the Caninsulin/Vetsulin more, so that we could take a reading of 102 and turn it into a reading of 85.

I think if you can do some work on Zoe's food to eliminate the 200 point drop in 2 hours, you'll get a flatter, more even curve that would get rid of the mid 300's at 8 hours post food and insulin. She may indeed need a bit more insulin, but I'd love to be able to deal with that 200 point drop because when you're going down that rapidly, you can stir up the counteregulatory hormones that drive bg's up.

Welcome to you both!

[Zoe's Mom]

Sandy,

I don't see anything in Zoe's curve that I'd call borderline hypoglycemic. :)





The thing about a borderline hypoglycemic episode isn't related to the particular curve she just had done.

Since the cushings started, there have been only 3 days (with daily urine testing) where Zoe tested negative for glucose. On the 2nd and 3rd days (which were about a week a part), I hadn't even intended to test her when I did since I really don't expect anything other than a positive result after hundreds of tests. Anyway, on the particular day, she did not greet me at the door when I got home. She always does that, even when she got sooo sick and had to be hospitalized in January. I had to call her several times to get her off her dog bed. Anyway, I brought her outside and she slowly walked to the grass to "relieve herself". I tested her urine and it was negative. So, I gave her some caro-syrup and she perked up a bit.

My concern with putting too much faith in the curve that the vet did was had I brought her in on what happened to be one of the 3 days where her urine had no glucose in it, I am sure the #s would have been in the 100's or even less. It is my concern that because of her cushings her BGs are varying greatly on a daily basis. If she got too low on the 14 units 2x a day, and hits another day where she is low for some reason, if I increase the dosage to say 14.5 or 15 units, I might endanger her. So, I am really leaning towards home-testing even though my vet discouraged it.

My step-dad is diabetic, and obviously checks his BG several times a day. I was wondering if with home testing, if I should be adjusting her dose of Vetsulin just like a human would or use the home BG testing for more long term monitoring to alter the dosages slowly. I was told (and have read) that it takes the dog's body several days to adjust to the new dosage, so I should change slowly, right?

Anyway, I have to run out and pick up my daughter from school. I'll check for replies later! Thanks! Sandy and Zoe

[BestBuddy]

Welcome Sandy and Zoe,
Good to see you here.
Jenny & Buddy

[We Hope]

The thing about a borderline hypoglycemic episode isn't related to the particular curve she just had done.

Since the cushings started, there have been only 3 days (with daily urine testing) where Zoe tested negative for glucose. On the 2nd and 3rd days (which were about a week a part), I hadn't even intended to test her when I did since I really don't expect anything other than a positive result after hundreds of tests. Anyway, on the particular day, she did not greet me at the door when I got home. She always does that, even when she got sooo sick and had to be hospitalized in January. I had to call her several times to get her off her dog bed. Anyway, I brought her outside and she slowly walked to the grass to "relieve herself". I tested her urine and it was negative. So, I gave her some caro-syrup and she perked up a bit.

My concern with putting too much faith in the curve that the vet did was had I brought her in on what happened to be one of the 3 days where her urine had no glucose in it, I am sure the #s would have been in the 100's or even less. It is my concern that because of her cushings her BGs are varying greatly on a daily basis. If she got too low on the 14 units 2x a day, and hits another day where she is low for some reason, if I increase the dosage to say 14.5 or 15 units, I might endanger her. So, I am really leaning towards home-testing even though my vet discouraged it.

My step-dad is diabetic, and obviously checks his BG several times a day. I was wondering if with home testing, if I should be adjusting her dose of Vetsulin just like a human would or use the home BG testing for more long term monitoring to alter the dosages slowly. I was told (and have read) that it takes the dog's body several days to adjust to the new dosage, so I should change slowly, right?

Anyway, I have to run out and pick up my daughter from school. I'll check for replies later! Thanks! Sandy and Zoe

Here's the thing about testing urine--you don't see glucose in urine unless you're over the renal threshold and stay there for a while--then glucose starts spilling into urine:

http://petdiabetes.wikia.com/wiki/Renal_threshold

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

"Urine only tests positive for glucose if the blood glucose concentration remains above the renal threshold for a substantial period of time. This occurs when glycemia reaches 180-220 mg/dL (10-12.2 mmol/L) in the dog."

So a urine test can tell you if you're OK or not for high bg's (hyperglycemia), but it can't possibly tell you if you're too low (hypoglycemia) or simply OK. Testing blood for glucose with a meter can tell you exactly how you stand right after you do the test; it can tell you if you're high and how high, can tell you if you're low and how low, as well as if you're where you should be.

People with diabetes may be using any number of treatments to control their blood glucose. While it used to be that those with Type 2 were given oral meds for it, that trend has been changing and you now see some people who are not Type 1 (insulin-dependent) who are using some insulin as a treatment.

If we stick to those who are insulin-dependent for the sake of an example here, those who are Type 1 use 2 types of insulins. One which is either intermediate acting (Novolin N, Humulin N 70/30, Vetsulin) or long acting (the old Humulin U, Lantus, PZI, Levemir) for a basal--the body's basic needs without food:

http://petdiabetes.wikia.com/wiki/Basal

And a fast or rapid acting one (Novolin R, Humulin R, Novolog, Humalog, Apidra) to cover the meals they eat called bolus:

http://petdiabetes.wikia.com/wiki/Bolus

What most people are adjusting is their fast or rapid acting insulin that takes care of the meals they eat. It starts working quickly and doesn't have a lot of duration.

You're right about making changes with Zoe slower. Making too rapid or too many changes can get the counteregulatory hormones set into motion:

http://petdiabetes.wikia.com/wiki/Insulin#Complements_to_insulin

These are the ones who raise the bg's when they think something's up such as hypoglycemia.

http://petdiabetes.wikia.com/wiki/Hypoglycemia#Aftermath

A single hypoglycemia or near hypoglycemia episode can result in hyperglycemia for up to 3 days following it. In response to the threat of low blood sugar, the body releases counter-regulatory hormones intended to raise bg's; the body's way of trying to save itself.

http://www.vetsulin.com/PDF/20585.pdf

Page 21-Somogyi Effect.

Making changes too fast or too many at once can also be what sets up Somogyi rebound where raising the insulin dose makes the bg's swing from highs to lows. When the bg's go too low, those counteregulatory hormones go to work and then send the bg's too high.

http://petdiabetes.wikia.com/wiki/Somogyi

http://www.vetmed.auburn.edu/sac/mededu/diabetes/graphics/somogyi.gif

This is a good example of how quick insulin changes start and keep Somogyi Rebound going.

Hope at least some of this helps!

[k9diabetes]

Vets often discourage home testing, which is unfortunate. My guess is it's a combination of not knowing what to do with the information it provides since they are not taught much in the way of hands on management of blood sugar and also concern about losing control of the dog's diabetes management.

I understand the worry... some people will take the readings and use them to make bad decisions. Possibly even life threatening decisions.

But that's not what you're doing here. You just want more information.

After hearing about Zoe's couple of possibly hypo experiences, I know you could get a lot of benefit from home testing blood sugar because it's the only way to KNOW if the blood sugar is low. A negative urine test means the blood sugar is anywhere between 0 and 180 - not very specific!!

If all you ever do is use it to check for lows, it will be worthwhile.

I have yet to meet a vet among the dozen or so I've talked to about home testing who knows that blood can be taken somewhere other than the ear either. So they mostly are not familiar with how easy it is and how well tolerated it is. After all, ears aren't the easiest place to get blood from a dog so I can see how they would think it's difficult.

The great thing is none of the stuff requires a prescription so you don't need anyone's permission to home test. If you want to do it, go for it. I know you'll be glad you did.

You can start with just monitoring and talk over the information you gather with the vet to formulate the best insulin plan. Down the road, if you want to more actively manage Zoe's regimen you can. Or you can stick with you and the vet as a team.

Low cortisol will tend to make her sensitive to insulin so if the cortisol is dipping very low, even if just for part of the day, that would be a consideration for keeping her blood sugar higher to keep her safely above 85. You will have to watch her carefully if her cortisol levels are fluctuating.

And diet is a good way to make small changes in the balance of food and insulin to possibly flatten out her curve.

Natalie

[Zoe's Mom]

Thanks for ALL the great information. She's already on diabetic dog food, so other than feeding her at different times or in small meals throughout the day, what else could I do to flatten the curve??? or would I just play with the feeding schedule and do curves at home to see what works best?

Also, on her diet, she is still starving. The vet says to feed her more. I've been giving her a mid-afternoon snack and upped the volume she gets at 7:30 a.m. and p.m. as well. Obviously this will play havoc on the BGs as well. I asked the vet if instead of feeing her more of her kibble that I could give her a snack of something low carb like cottage cheese-- but he suggested something high fiber like broccoli. I recall reading something about that certain diets are good for diabetic dogs but that the opposite type of diet is good with cushings. I was wondering if you had any suggestions about additional snacks for her.

My heart goes out to her with this blindness. Do you have any suggestions about how to make her more confident and/or comfortable with it? She walked nose first into my bedroom door yesterday (it is usually wide open and was just cracked and she didn't see it). We already are trying to keep all the walking path's clear (of children's toys/debris) and have installed a motion controlled flood-light into our dog run that is activated when she uses the doggy door (so she can find her way back inside at night).

I've read that a lot of people use the glucopet monitor, and I looked at it online but the $100 pricetag is high. Is there a human monitor that might work or do you know of any place I can buy a used glucopet monitor (from someone who's sweet pup has passed on)?

[k9diabetes]

Hi Sandy,

I just have a minute now and will reply more about diet later.

I think it's easiest to start home testing with a regular meter for people.

You can usually get them free or nearly free after a rebate and the strips are much less expensive also.

There is some variation with the meters when used on dogs - they tend to read the BG somewhat low. But it's a great place to start and once you get home testing down and get an idea of how accurate your meter is with Zoe, you can move on to an animal-adjusted meter if you want.

I use a OneTouch Ultra - have had it three years and have tested it many times against lab values. It's a consistent average of 30 points low on Chris' blood sugar. I buy the strips through hocks.com where they are less expensive than if I buy them at a pharmacy. I paid nothing for the meter after a rebate.

The thing with animal adjusted meters like GlucoPet and AlphaTrak (I have or have had both) is they don't actually read a dog's blood sugar more accurately. Instead they have been adjusted to bring the readings to the average difference on the meter with a dog's blood in a number of tests. So they can be very accurate, if your dog fits the average. They too can be inaccurate. Given the expense, I prefer to use my OneTouch Ultra.

OneTouch is a good meter with many dogs. Bayer Contour is another I've seen used frequently. Freestyle tends to be good with smaller dogs so might be a good choice with Zoe.

It isn't the meter that's the big cost over time - it's the strips.

More later on tweaking diet... most likely a carby addition to her meal that would be converted to glucose quickly to match that fast drop in blood sugar during the first two hours.

Natalie

[ladysmom06]

Hi Sandy,

Welcome to you and Zoe. I've been following your story on the cushing's board - my Lady also has diabetes and cushing's. Having both diseases can make things more complicated. We use trilo for the cushing's and Humulin N for the diabetes. Lady is doing really well:D:D - it took us awhile to get both diseases regulated but it can be done. She is on a homecooked diet and I hometest. She was dx with diabetes in Sept.06 and I didn't start hometesting till Feb 07. I test her from the ear - wish there was somewhere else to do it but she won't let me anywhere near her mouth - I did try the tail and I could never get enough blood there. Hometesting gives you such peace of mind - my vet really encouraged me to do it. I took Lady to the vet and had one of the techs show me how to do it. It really isn't hard at all - if I can do it anyone can. I use the one touch ultra meter - it doesn't require a lot of blood. When I bought it I had a rebate coupon so it didn't end up costing anything. In the beginning I used a lot of strips - really wasted a ton of them - now I know better to wait until the blood beads before testing - still waste one now and then when she won't stay still. Lady gets 2 meal a day - around 6 in the morning and 6 in the evening followed by 5 units of Humulin. We added a small meal at night right before bedtime - she was dropping low and I was afraid she would go lower while I was sleeping and I wouldn't know. That's where the home testing helps a lot. When she was first dx I used the urine sticks but they were never consistent with the curves the vet was doing - I just use them now and then to check for ketones.

Sorry if you mentioned it but when did Zoe start the trilo? Before Lady started the trilo her bg's were all over the place. Even after being on trilo for a few weeks with her cortisol #'s coming down - her bg's were still high. We started getting flat curves first and then after a couple of months her bg's were finally down where the vet wanted them. Is Zoe due for another ACTH test soon and what dose of trilo is she on? Good luck with Zoe - I'm sending positive thoughts that you can get this all sorted out. Hugs to the two of you.

[Zoe's Mom]

Hi Lynne & Lady,

Zoe started Trilo on Feb. 4 or 5, 50 mgs 1 x a day...so we are at about 3 months on it now. She just had a follow up ACTH and the vet says she isn't due for a while now. I'll probably go pick up a glucose meter later today or tomorrow. I really wish I had been more proactive and ignored my vet's advise to not do home testing... It has already been over a year with diabetes. I'll post again after I actually try to test her. :-) Sandy

[k9diabetes]

Hi Sandy,

Tweaking Diet

Diabetic dog food may actually be contributing to the large difference between her highest and lowest blood sugars. Not that you have to change it. There are other ways to tweak the diet and in this case I would simply add something readily digestible and even a little carby and give it to her with her meal and injection. Could be a cracker or some rice or some bread... is there something along those lines that she likes?

That 30% semilente part of the insulin is going to work faster than her food is being digested. I put up a general discussion of the balance of food and insulin here: http://www.k9diabetes.com/insulinfood.html.

Diabetic dog foods are designed to be digested slowly and last a long time with the idea of being digested and converted to sugar at approximately the same speed as the dog's body absorbs and uses the insulin injected. But Vetsulin sometimes works too fast for diabetic dog foods, which causes that quick drop in blood sugar from 300s to 100s during the first couple of hours.

So you can add some food to her meal that should be digested and converted to glucose quickly. Starches work well. For some rice works well. You may have to experiment a bit to see what Zoe likes and works well for her. You'd keep her schedule the same, only changing what she's being fed by adding something that will get going fast.

All of which can wait until you get testing sorted out and take a look at what her blood sugar is doing during the day. There's no huge rush to make diet changes as she's fairly well regulated now.

Hunger and Snacks

As far as being hungry, how is her weight?

That's what I would go by as far as increasing, decreasing, or maintaining how much food she's getting.

If you do want her to gain some weight, then you can increase the amount of food and you will probably need to increase the insulin some too. I can't tell you how much but home testing will sort that out for you.

Broccoli is a great snack if she will eat it as it's extremely low in calories and the glycemic index. It's like a freebie snack. Chris wouldn't eat a piece of broccoli if you paid him but some dogs really love it.

I wouldn't give cottage cheese in the afternoon. In fact, I wouldn't give a snack in the afternoon (other than broccoli or green beans) at all based on the curve you posted. Her insulin's effect is waning in the afternoon and any snack will drive up her blood sugar.

I'm not aware of any dietary suggestions for Cushings and typically with diabetics the diabetes controls the diet as it's such a huge player in their regulation. But the Cushings folks can correct me about the diet... I think it may be that Cush dogs tend to be prone to pancreatitis so fat would be limited. That may be the issue.

Blindness

Chris has been blind for nearly four years now. Since I don't know Zoe, I don't know how she will respond but I can tell you that probably 95% of all the diabetic dogs I've seen through message boards over the years adjusted quickly and well to being blind, almost always better than their humans adjusted to it.

We were devastated when Chris lost his sight. Chris? Not so much.

Until he got too old to do it, he went on daily walks, traveled with us, staying in strange places and motel rooms, went wading and even swimming in the river on a long lead... most of what he used to do. He just heads out and figures we will protect him from most of the bumps in life. He learned to navigate the house and we limit furniture moving as much as possible, though we have moved a few things around and he has adjusted.

You've done some great things already! Just check around for obstacles that could hurt her, like sharp pointy things in the house or yard or uncovered pools. We put throw pillows in front of a sharp corner on a media stand... stuff like that. Some people use scents or runners to mark common paths through the house.

But you will probably find that Zoe is very resilient and flexible and learns to get along just fine. Fortunately for dogs, they don't lie around wailing "Why me, why me.... oh poor me!" We usually do that part for them! :) They get on with life, which is one of the things I love about them.

-------

Okay, that's enough prattling on for tonight! Good luck with home testing. I know you'll love it.

Natalie

[Zoe's Mom]

Hi Natalie,
I bought a Freestyle (Freedom Lite) monitor. Did some test runs on myself to make sure it was working, and it was amazing the difference in readings from one minute to the next. So then I tried it on Zoe at 3:00 and it said 216. I didn't believe it so I tried it again and it said 364. I've read that with human monitors you need to do some sort of conversion. For instance, a link on this website regarding glucose monitors shows there is a substantial difference between what the meters say. http://www.animaldiabetes.com/validation
I saw comments by others about finding a 40 pt. - 25 pt. difference between their meters and the vets. What am I supposed to do? Bring her to the vet & compare their results? Thanks. Sandy

[k9diabetes]

While there can be some small difference in two readings taken close together, the difference should not be nearly as much as you got.

Which suggests that there's a problem with the meter or the strips, the coding, or how you're filling the strips. I don't think those readings are accurate.

I would expect two readings taken close together, whether on you or on Zoe, to vary by less than 30 points and generally by quite a bit less than 30.

Congrats on getting two tests from Zoe!!!!

At some point you will want to check your meter against some blood drawn by the vet and analyzed with a lab machine. But you don't have to worry about that yet. First, you'll need to figure out what's not working with the current meter as I have no doubt there's a problem there somewhere.

Will write more later,

Natalie

[Zoe's Mom]

Hi Natalie,
Alright. I tried again today to see if the problem was me or the monitor. I read the directions carefully it appears I was scraping the test strip against the test site (and it says not to do that) so maybe that messed it up? Anyway, I tested myself first without scraping it and within seconds of each other I got 89, 114,113, 100 and 98 (just plowing through these test strips!) These all seem to be within 20% of each other (better than my range of 40 - 159 yesterday), so the monitor should be fine, right? So I should be at about 100 right? Then I did Zoe and she got 222 and 191. So, she probably has around 200, right? And if that is true, then what does she really have? Thanks! Sandy (and Zoe)

[k9diabetes]

That sounds more like good readings so I think you're okay.

There's no magic number to adjust the readings. Eventually you will want to compare a test with your meter against a sample put through a lab analyzer by the vet. This should be done even if you purchase an animal-adjusted meter.

I've seen Freestyle readings that matched lab readings exactly and I've seen them be as much as 60-80 points low, which was true for Chris. From what I've seen over the years from others, Freestyle tends to be more accurate on small dogs. I know of a mini Schnauzer who got lab-quality readings on a Freestyle meter and the AlphaTrak gave somewhat high readings because of its adjustment.

Your reading sounds like it matches the curve fairly well, depending on what time of day you tested so it may be in the ballpark.

For now, I'd test at premeal and then, if you can, 2 hours later and see if you get that same low reading at the 2 hours post-meal mark and how low it is on your meter.

What you're looking for right now is general information - is her BG high or low? And trends. Does she usually take a big drop during the first two hours after her food and insulin and if so, how much is that drop?

If she does routinely drop, it would be good to add something to her meal to try to counter that. You could use your meter to test to see if you can shift her curve to a flatter profile - even if at first all of the readings are higher. You'd start by trying to flatten out the curve and then, when you've accomplished a smaller difference between the highest and lowest blood sugar, you could very slowly and carefully increase the insulin dose to bring all of the numbers down into a good range.

Hope that makes sense!!

For now, just start doing some testing and recording the time you test, the reading you get, and how long after food and insulin the test was done. Check that potential low spot of 1-3 hours after food and insulin for a few days and see what you get. And then we can look at the numbers and see how it's going.

And, of course, if you're concerned about her BG being too low, test her.

You can combine this with urine testing until you can have your meter checked. If her BG is 200 on the meter, there shouldn't be much glucose in her urine. There will be more glucose in the urine just before her meal and injection, per the curve, as that's when her blood sugar is likely in the 300s.

I'll follow up later with a post on how you do the lab comparison.

I'm so excited for you Sandy!! I'm even hoping you will eventually be able to convert your vet into a home testing proponent.

Natalie

[We Hope]

Sandy,

I have a ton of video links on how to use the meter:

http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20.10.7:7/general_content/General_Content_0000357.htm

http://mfile.akamai.com/36726/wmv/abbottstore.download.akamai.com/36726/diabetes/videos/freedomlite/Eng-S2B-TestStrips.wmv

How to use test strips

http://mfile.akamai.com/36726/wmv/abbottstore.download.akamai.com/36726/diabetes/videos/freedomlite/Eng-S4A-TestProcedures.wmv

Test procedures

http://www.abbottdiabetescare.com/static/content/document/ART12214_Rev-B_web.pdf

Online owners' manual

Finally found that this meter does not have control solution included in the kit-some do and with others, you need to buy that separately. If you want some control solution for this meter, try checking with the pharmacy where you bought it; online pricing for the control solution I've seen have been under $10.

Some of the meters and strips are "pickier" than others when it comes to how much blood, where it should be placed, etc. (I promptly killed off all the starter strips of a AccuChek when learning how to take blood glucose for my mother--too much blood meant an error reading as well as too little. :D )

http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/30.10:10/general_content/General_Content_0000120.htm

Be sure to register your meter and sign up for Friends For Life--this will get you a free upgrade every time Abbott comes out with a new version of your model meter.

Now--as to what's normal for a person, we're going to need to talk about whether you tested yourself fasting or not:

http://www.mayoclinic.com/health/blood-sugar/SA00102

"What is a fasting blood sugar test?
A fasting blood sugar test measures the amount of sugar in your blood after you fast for at least eight hours or overnight.

"What's normal?
A normal fasting blood sugar result is lower than 100 milligrams of glucose per deciliter of blood (mg/dL).

"What is a random blood sugar test?
A random blood sugar test measures your blood sugar at any point in time, not necessarily a certain amount of time after a meal, snack or beverage.

"What's normal?
A normal random blood sugar level hasn't been clearly defined. However, even if you've recently eaten and your blood sugar level is at its peak, your random blood sugar level shouldn't be higher than 200 mg/dL."

[Zoe's Mom]

thanks for the info! I would never have tried home testing without your support! I am absolutely amazed at how much time you give to absolute strangers. Truly amazing! I feel like I've poked & prodded Zoe enough for a couple of days, so in a few days I'll try a curve on her and see where she is at & then try tweaking her diet a bit and update with how she is doing.

On another note, my other schnauzer (non diabetic & non cushings thank goodness!)Sadie was eating grass & vomiting today, and has a type of doggie cleft-palate inside her mouth which is causing her more & more problems with choking & breathing as she eats as she ages-- almost thought I'd have to do some sort of doggie heimlich on her this evening she was having such a hard time eating & breathing-- so I am sure I'll be at the vet with her soon too! Perhaps I'll drag Zoe along also to compare my monitor with the vet's.

THANK-YOU again!

[k9diabetes]

If Zoe will let you, you can test her at the vet's office and then have them do a sample. Some vets have an in-house analyzer and can check the sample just for glucose so don't need a lot of blood and can provide results in about 20 minutes.

If no in-house analyzer, then they have to send it out to a lab.

I have at times checked Chris' BG in the lobby on my meter, sent him in to have the blood drawn, and then checked him again on my meter after the draw.

This helps distinguish any vet stress that might drive up the blood sugar.

Say I get 129 and 137 on my meter and the vet gets 162.

That would be typical with my meter, which runs about 30 points low, and would suggest no vet stress in the glucose levels since it was essentially the same before and after the vet drawing blood.

But if I get 129 and then 225 and the vet gets 255, then I know that stress likely spiked his blood sugar.

If I didn't do the "after" test, I would think my meter was way off (129 versus 255) when actually his blood sugar rose because he was being handled.

Fortunately, Chris doesn't vet stress, at least as far as blood sugar is concerned, but some dogs do. Chris' BG usually drops at the vet. I understand it can be a huge problem with cats.

If Zoe won't sit still for testing while at the vet, just have them put a drop of the blood from their sample on a slide and you can test that drop with your meter.

Natalie

[k9diabetes]

Also hoping to hear how Zoe is doing.

[eyelostit]

Hi Sandy and Zoe,

I wanted to mention to you my Niki was started out on DCO and always had high BG reading, this went on for about 2 yrs maybe, you can read it in my story about Niki, as far as lowering the BG only thing that really helped me was decreasing the dogfood and adding veg's, and turkey,

about 3 yrs ago I quit the DCO, tried Innova etc, all of them and settled on Nutro Lite or Nutro Senior, she only gets about 1/3 cup of this dry dog food. But in an emergency situation if I have to rush out somewhere I'd give her 1 3/4 c of the dry. But I just hate when I have to do that :o

[Zoe's Mom]

Hi there-
Zoe seems to be doing well. I still haven't done a full curve on her yet-- it seems that with all the running around with a pre-schooler and kindergartener (school, piano lessons, ballet, soccer, girlscouts etc...oh and my work) I am never home for a full day to do it. Things should be settling down a bit in early June so hopefully then.

One thing I did notice was the other day I had to let Zoe's collar out a notch! And when I did it, I noticed that our groomer (who last saw her at the end of April) had also let it out a notch so we are no longer on the smallest collar size (down from the largest a year and 1/2 ago!) Only 3 more notches to go on it and she'll be back to her original size. :-)

I'll post again after I do her curve or before if anything comes up. :-)

Sandy (and Zoe)

[k9diabetes]

Congratulations on her expanding collar size! :)

Natalie

[Zoe's Mom]

Hi, I have a question regarding Zoe's diet. She has cushings and diabetes. Her BG's have been getting higher and higher, and even with increasing the insulin doses, I am not staying ahead of it. For instance, her low yesterday was 386 and that was on 19 units Vetsulin 2x per day. 2 weeks ago her low was 380 on only 18 units..... Anyway, the vet thinks her adrenal glands are interfering with the absorbtion of the insulin. She's 24 lbs. My husband and I were talking about switching her diet to see if that makes a difference. Right now she's on Purina DCO. Any recommendatoins on switching her to a home-cooked diet?

[peggy0]

Have they done curves on her to make sure she's not rebounding? Several people on the board do home cooked meals so I'm sure you will get some great advise. I don't know anything about cushings so I can't help you.

[Zoe's Mom]

She's had many many curves and is not rebounding. It just appears that the insulin isn't working well anymore, which I understand isn't uncommon with a cushinoid dog. :(

[k9diabetes]

When was the control of her Cushings last tested?

As a rule, diet changes mainly change the "shape" of the curve. If the Cushings is interfering with the effect of the insulin, a diet change isn't likely to solve that problem.

Not that you can't change diets anyway! :)

But how is the vet tackling his belief that the Cushings is throwing off her BG control? That would be the thing to tackle first.

I need to go back and look... is the Cushings being treated? If so, what with?

Natalie

[k9diabetes]

Looks like it's trilostane so presumably the vet has done an ACTH?

[Zoe's Mom]

She's had ACTH's done.

An ACTH in April 2008 when here BGs were much lower (216 low for the day)was 1.2 pre and .9 post.

Then on 11/6/08 the following tests were done
BG 10:50 411
Fructosamine 626
ACTH pre 3.2
post 4.9 after
Increased vetsulin to 16 u 2/x day

She gets 50mg trilostane 1 x day. And she's up to 19 u. vetsulin 2x a day.

On a good note, she is still slowly gaining her weight back, and is up to 25.2 lbs. from 20 lbs 1 year ago. (Her max weight ever was 28 lbs).

[We Hope]

Sandy,

Since Zoe is a schnauzer and they are prone by breed to running high blood lipids/cholesterol, I'm wondering if that's been checked lately, as this also can be a reason for insulin resistance.

Have a look a Kramer's thread--he's also a schnauzer and is starting on meds for his blood lipids.

Kathy

[k9diabetes]

I'm a little confused about the vet's approach here... if he thinks the adrenals are interfering with her blood sugar control, that would suggest that the Cushings is not currently controlled.

He hasn't reassessed her cortisol levels with a recent ACTH?

I know some dogs need Trilostane twice a day to maintain good control over the cortisol levels.

I would want to know what the cortisol levels are. I know the ACTH is kind of a pain with a diabetic dog as it raises their already high blood sugar for a day or two but...

Cushings control and blood sugar control are directly linked. If the blood sugar is rising, most likely the cortisol is as well.

It also seems like you haven't ever seen any really good blood sugars. More insulin likely is required. She could get up to 24 units of insulin twice a day before I'd start to be worried about the amount of insulin, even if she didn't have Cushings.

I will take some time later to go back through your thread and see what answers I can find.

Natalie

[Zoe's Mom]

Thanks Natalie. The vet says that the newer information he is getting from specialists is that as long as Zoe's post ATCH numbers are at 7 or below, she is adequately controlled on the cushing's side of things. He won't adjust her cushing's meds without another ATCH (which is a very expensive test). So, we were hoping that if we significantly reduce her carbs through diet, we might have better luck keeping the bg's down.

[k9diabetes]

I agree that under 7 is good.

Question is whether her cortisol is currently under 7 - that's where I have my doubts since it's been quite a while since an ACTH was done.

But it could also be that the Trilostane doesn't control her cortisol all day and it is rising during the afternoon and evening. I believe... the Cushings folks could better confirm this... that the timing of the ACTH when on Trilostane is very important and that a test in the morning wouldn't necessarily tell you whether her cortisol was controlled for 24 hours.

Her fructosamine in November was very very high even though her cortisol control was good so it seems like there is a combination of possibly poor cortisol control... but I suspect some of the problem is just plain needing more insulin than she's getting.

She would have needed a lot less insulin to control her blood glucose back when her cortisol levels in April 2008 were on the low side.

So it's natural that now that she has more circulating cortisol she needs more insulin for blood sugar control.

Diet may make some minor adjustments, but, as I said, it's like to change the "shape" of her curves more than it will reduce her blood sugar.

Since there is an issue with the expense of the ACTH test and it's not clear whether cortisol is truly behind her higher blood sugar, I'd suggest another increase in her insulin dose, working up toward 24 units if necessary. That will tell you whether it's just that she's not getting enough insulin.

If it's the cortisol, you would see the insulin dose go up and the blood sugar values stubbornly refuse to go down, even at 24 units twice a day.

Did that make any sense? :)

Natalie

[Zoe's Mom]

It does make sense. I'll probably be scheduling another ATCH in April. So, until then, I'll inch up the insulin if the BGs remain high and just keep her diet the same. THANK YOU sooo much for your advice!

[Margaret Boyle]

Hallo Zoe's Mum,
I just wanted to say hallo as I have a Miniature Schnauzer called Lucy and sometimes it is helpful to compare notes as we have found and been told they are quite difficult to regulate. I am now going to read Zoe's story I am just finding my way around and have not read all the dog's stories but it is a great site for information and everyone is so ready too help. I am not blood testing yet but waiting on my meter to arrive.

Hope to speak to you soon

[Zoe's Mom]

We're still having problems getting Zoe regulated. Her last curve was on 1/9/09 and here's what we got when she was on 16 units 2x a day:
9:00 491
11:00 a.m. 425,
1:00 p.m. 397
4:00 450
5:00

Her other BGs were:
1/12/09
Home Freestyle 3:26 p.m. 351


2/5 1:00 p.m. 380
Increased to 18 units as result

2/28 12:30 386
Increased to 19 units

Weight 25.5 lbs.


On 3/22 12:30 p.m. her BG “HIGH” (which I understand is above either 500 or 600 on my vets meter). And this was her typical daily low point on the vetsulin. New bottle of Vetsulin. Increased to 20 units.

On 3/24 She received approximately 18.5 – 19 units at 7:45 a.m. And, at
10:45 a.m. her BG was only 224. For cushings she had an ATCH test done that day and the numbers are .9 pre and 1.3 post (a year ago she was 1.2 pre and .9 post, and in November 2008 she was 3.2 pre and 4.9 post.)

So, on 3/24 her ACHT was
.9 pre
1.3 post

at 2:00 p.m. BG- "HIGH"
Fructasomine 564 (which is better than her November fructasomine of 626)
Weight 25.2

3/25 20 units
2:42 p.m. BG 244 (taken at home on Freestyle)

I've tried to test her at home multiple times over the last few days and for the most part, haven't been successful. I worry about increasing her vetsulin dosage because of these surprising lower readings lately.

The vet thinks the cushings is ok. He thinks we should switch back to Humulin N (which she was on one year ago when diagnosed with cushings). The problem she had was she was metabolizing it so fast -- it was completely out of her system within 7 hours. He wants to start her out at 12 units 2x a day. My thought is her BGs will be sky-high in the afternoons and that it would be reasonable to give her a 3rd shot each day, which the vet says he has never had to do before but will support whatever I want to do. So, I figure I had better get better at this home testing.

My questions are what can I do to make it easier to draw blood from her? I've been doing it in the pad of her foot and don't always get any blood or enough...and she winces when I do it. As a result, I hate to do it.

Also, is 12 units a good number of units to start on humulin? She was on 12 units of humulin n a year ago when she started vetsulin....and her vetsulin dosage today is 2 times as much as it was a year ago when we started. I can't seem to find any tables or charts which explain how to switch from vetsuilin back to humulin N.

Or, are there any other options other than humulin n or vetsulin?

Also, I've noticed quite a bit of scar tissue around the scruff of her neck and shoulders where we've been injecting her for these last 2 years, which makes it painful for her if we inadvertently inject her there. Are there any tricks to finding scar-free skin or do you have any better locations to inject her (she doesn't have a lot of skin to grab and has a giant cyst on her shoulder which eliminates a large area for injecting her)???

I look forward to any advice and/or help with my sweet Zoe! Sandy

[k9diabetes]

Her Cushings results look perfect and the increase in insulin seems to have done well for her also.

As far as injection sites, there are many places you can inject:

From: http://www.bddiabetes.com/us/main.aspx?cat=1&id=395

http://www.bddiabetes.com/resource.aspx?IDX=2551

Chris built up scar tissue quickly in the scruff so fairly early on we moved to the side of the chest and that's where we injected for the rest of his life. He didn't build up thick skin or scarring there.

The scarring in the scruff may be interfering with Zoe's absorption of the insulin and changing sites in general can affect the absorption.

The standard way to change doses of insulin is to reduce the dose 25% which would be 4-5 units. So I'd say not more than 15 units of NPH and 12 units seems like a good place to start, especially if you also change injections sites to an area that hasn't been used before and so is scar free.

Don't you hate it when you finally see some good numbers and it freaks you out! :)

I believe we have a tutorial for every site that's commonly used except the ear but you could probably use the cat video as a guide for ear testing. It does work for some dogs, just not many. But we have a tutorial for the lip, paw pad, base of tail, and callous (Zoe doesn't likely have a callous...): www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html).

The AlphaTrak video I believe includes testing the ear: http://www.alphatrakmeter.com/en_US/en_US/video/obtaining_blood_sample_video.html

I know it doesn't feel like it, but you ARE getting there with reducing her blood sugar. Getting down into the 200s is very exciting!!! :) And don't worry if she needs as much as 25 units of insulin to regulate.

Also, try not to pressure yourself too much on testing. Practice, try it, let it go for a day or two. No point in either of you getting frustrated. You will likely find something that works for you and Zoe. And if you don't, that's okay. Some dogs just can't be tested.

You might try the lip unless it's very clear she won't tolerate it. A lot of dogs are better about it than you might think with some practice. Chris never liked having his lips handled before he was diagnosed but he got used to the routine of being tested there pretty quickly.

Natalie

[Margaret Boyle]

We're still having problems getting Zoe regulated. Her last curve was on 1/9/09 and here's what we got when she was on 16 units 2x a day:
9:00 491
11:00 a.m. 425,
1:00 p.m. 397
4:00 450
5:00

Her other BGs were:
1/12/09
Home Freestyle 3:26 p.m. 351


2/5 1:00 p.m. 380
Increased to 18 units as result

2/28 12:30 386
Increased to 19 units

Weight 25.5 lbs.


On 3/22 12:30 p.m. her BG “HIGH” (which I understand is above either 500 or 600 on my vets meter). And this was her typical daily low point on the vetsulin. New bottle of Vetsulin. Increased to 20 units.

On 3/24 She received approximately 18.5 – 19 units at 7:45 a.m. And, at
10:45 a.m. her BG was only 224. For cushings she had an ATCH test done that day and the numbers are .9 pre and 1.3 post (a year ago she was 1.2 pre and .9 post, and in November 2008 she was 3.2 pre and 4.9 post.)

So, on 3/24 her ACHT was
.9 pre
1.3 post

at 2:00 p.m. BG- "HIGH"
Fructasomine 564 (which is better than her November fructasomine of 626)
Weight 25.2

3/25 20 units
2:42 p.m. BG 244 (taken at home on Freestyle)

I've tried to test her at home multiple times over the last few days and for the most part, haven't been successful. I worry about increasing her vetsulin dosage because of these surprising lower readings lately.

The vet thinks the cushings is ok. He thinks we should switch back to Humulin N (which she was on one year ago when diagnosed with cushings). The problem she had was she was metabolizing it so fast -- it was completely out of her system within 7 hours. He wants to start her out at 12 units 2x a day. My thought is her BGs will be sky-high in the afternoons and that it would be reasonable to give her a 3rd shot each day, which the vet says he has never had to do before but will support whatever I want to do. So, I figure I had better get better at this home testing.

My questions are what can I do to make it easier to draw blood from her? I've been doing it in the pad of her foot and don't always get any blood or enough...and she winces when I do it. As a result, I hate to do it.

Also, is 12 units a good number of units to start on humulin? She was on 12 units of humulin n a year ago when she started vetsulin....and her vetsulin dosage today is 2 times as much as it was a year ago when we started. I can't seem to find any tables or charts which explain how to switch from vetsuilin back to humulin N.

Or, are there any other options other than humulin n or vetsulin?

Also, I've noticed quite a bit of scar tissue around the scruff of her neck and shoulders where we've been injecting her for these last 2 years, which makes it painful for her if we inadvertently inject her there. Are there any tricks to finding scar-free skin or do you have any better locations to inject her (she doesn't have a lot of skin to grab and has a giant cyst on her shoulder which eliminates a large area for injecting her)???

I look forward to any advice and/or help with my sweet Zoe! Sandy


Hi Sandy,
I see you are having problems with Zoe's injections. Lucy my Miniature Schnauzer has also a lot of scar tissue round her scruff wich does make it difficult I inject further along the back and down the sides now you only need a small tent and like you I will be two years this December with Lucy not regulated.
Also your blood testing there are two small pads up behind the front legs very small ones and this where I get good drops from Lucy they are not on the paws they sit up the leg a bit you could try here.
The paw pads are very difficult to get blood from I have even tried heating them, with no luck. I hope this may help some. Some of the other guys might be able to help you on this as well. I see Zoe also has Cushings Lucy had the test a long time ago but they said she did not have it!
I sometime wonder! Hope this helps a bit. :)


LOL

[lab lover]

Have you tried Zoe's elbow pads this is the only place I can test Baby and I am new in doing this - she is a bigger dog yellow lab - I don't know if this would helped you but, you could try it. Baby's Mom/Ida

[Zoe's Mom]

I'll try the elbow pads tomorrow. Thanks for the suggestions!

[eyelostit]

Hi,

I use the tail method for testing, the 244 reading was good.

Usually going from Vetsulin to NPH the dose is less
Ex: 10 units Vetsulin --NPH could be 5 units, you most likely know this, the vet should advise you on this, its never the same dose as your former Vetsulin dose always less. (Some vets don't figure this right, why I have no idea )

I'd ask the vet about starting the 12 Units of NPH to make sure, can't figure why they are considering 3 shots a day, is this because of the cushings?

Thoughts anyone ?:)

[k9diabetes]

By the way, we had the same problem with NPH. Lasted about 7-8 hours. And we did give it three times a day. If Chris hadn't been allergic to NPH, we would have stuck with it three times a day as he got really good blood sugar control on that.

I actually found the three-times-a-day schedule more painful than four times a day. On three times, there was always one meal and injection that was at an abominable hour!

Natalie

[Zoe's Mom]

Hi Natalie (and everyone),

I was thinking about the bad time of day shot with the 3 shots.... and ways to avoid that. Have you heard anyone using a short-acting insulin in the interim between 2 shots? For example, NPH at 7:30 a.m., short acting insulin at 2:00 with snack, and then NPH again at 7:30 p.m.

Granted, she'll still get up pretty high between 2:00 a.m. to 7:30 a.m., but I was thinking this might be a compromise to avoid having to give her a shot of NPH at midnight.

Also, I tried checking her foot pad today and the pad higher up on her front leg today, and had no success. Also, her tail is sooo short (1/2 inch?), I am not sure where to even try testing her on it. Have you heard of anyone just keeping a spot on the dogs rear-end/upper thigh shaved to test? I tried testing myself on my thigh, and didn't even feel it & thought maybe that would be the same with her.... I am thinking of busting my husband's electric razor out to shave a spot on her (which of course he wouldn't be pleased about!).

Thanks for all your help! Sandy

[Margaret Boyle]

Hi Natalie (and everyone),

I was thinking about the bad time of day shot with the 3 shots.... and ways to avoid that. Have you heard anyone using a short-acting insulin in the interim between 2 shots? For example, NPH at 7:30 a.m., short acting insulin at 2:00 with snack, and then NPH again at 7:30 p.m.

Granted, she'll still get up pretty high between 2:00 a.m. to 7:30 a.m., but I was thinking this might be a compromise to avoid having to give her a shot of NPH at midnight.

Also, I tried checking her foot pad today and the pad higher up on her front leg today, and had no success. Also, her tail is sooo short (1/2 inch?), I am not sure where to even try testing her on it. Have you heard of anyone just keeping a spot on the dogs rear-end/upper thigh shaved to test? I tried testing myself on my thigh, and didn't even feel it & thought maybe that would be the same with her.... I am thinking of busting my husband's electric razor out to shave a spot on her (which of course he wouldn't be pleased about!).

Thanks for all your help! Sandy


Hi Sandy,
I see you are still having problems with getting blood from Zoe I don't know what setting you are using I have Lucy's set at 4 I use the pad on the front leg the one further up from the paw at the back. Squeeze the pad gently and apply lancing device put a bit of pressure on it then release the pad and wait a few seconds and give a firm but gentle squeeze and you should get a nice droplet of blood. I cannot get it from Lucy's tail as like you it it's very short
but I am working on it. I do not know about the thigh as I have never tried here! Lucy is fine with the small pads at the back of the front legs I do not know what lancet device you are using or lancets but Sandy Schnauzers are quite bad at giving blood. I have tried various places. Paw pads nothing, tail nothing, lip which she hates, but small pads success I hope this helps you will find a place Sandy so don't worry trial and error.:(
Let me know how you get on!


LOL

[Zoe's Mom]

Well, I busted out the electric razor (didn't do a completely thorough job so she wouldn't be bald if it didn't work), and after several tries, it was able to get enough blood for a sample! Also, other than the butt/leg massage she was thoroughly enjoying, she didn't even notice the pricks! :) So, later on this evening I'll do a better job shaving a that spot on her, and try again.

Also, she was at 436 which, comparatively speaking, isn't such a bad number for 4:40 p.m. considering this is her 2nd day on the new insulin.

[eyelostit]

Congrats on the testing ! ;)

[Margaret Boyle]

Good for you Sandy I might get that tip from you about the rear end
where exactly do you do it? The electric razor or clippers do not shave it
enough when I tried Lucy's tail I used an ordinary razor soaped it first then
shaved. :)

Congratulations ;)

[Zoe's Mom]

Hi Margaret,
Well, now even though I am able to get some blood at that location, after about 10 tries last night and today, it isn't enough to get a reading. I even bought slightly bigger lancets and tried putting a heating pad on her rear for a few minutes before hand to get the blood flowing...and other than giving Zoe a nice warm rear end, it didn't seem to help. Even tried her pad on her leg again with no success. I am thinking that this home testing just won't work for her. :( Sandy

[We Hope]

Zoe's Mom,

Please "recap" for us where you've tried to test Zoe and have had no luck. We have members who are testing in quite a few different spots and some have their own tips they can share with you as to how they make testing in their particular spot work for them and their dog.

We also probably have members here who are testing in places you've not yet tried with Zoe and they can give you their tips for how they're successful.

Kathy

[k9diabetes]

Hi Sandy,

Regarding the three shots a day, some people have used something like 9, 9, and 6 hour or 10, 10, and 4 hour schedules with faster acting insulin to cover the short period.

So for example, on a 9-9-6 schedule you can give:
Regular insulin at 4pm,
NPH at 10pm, and
NPH at 7am.

That's a six hour stretch for the Regular and 9 hours for the NPH. Any variation of that which your schedule can manage will work. If you're an early riser, you can do R 4am, NPH 10am, NPH 7pm.

10-10-4 is actually probably easier to do but might not provide enough coverage. Then, especially if you work during the day, you'd give the Regular insulin when you got home from work, like 6pm, and the NPH late in the evening and in the morning, maybe 10pm and 8am.

You would have to start with a VERY small amount of Regular insulin to see how Zoe does with it. Some dogs just drop too fast too hard with it. And it might require a more carby meal to work... only way to know is to try.

It would be much preferable to master home testing first as this type of regimen requires some careful monitoring in the beginning.

I will have to look back... did you already try Vetsulin?

Because NPH and Vetsulin actions are extended in a completely different way, the reaction to the other can be very different and potentially you could get more coverage from Vetsulin.

Regular typically lasts about 6 hours and peaks somewhere around four hours.

Natalie

[Zoe's Mom]

Zoe's Mom,

Please "recap" for us where you've tried to test Zoe and have had no luck. essful.



I've tried the pads of the feet, the pad higher up on her legs, her ear, and the patch I shaved on her rump. I was able to get enough blood at the rump location this evening by pinching the skin when I pricked it. Hopefully it wasn't a fluke and will work again tomorrow. I am afraid to try her lip.

[Fishslayer]

I am afraid to try her lip.

I was also scared to death of sticking Lucy's lip. Honest. She doesn't even feel it!;)

It took me awhile to get comfortable & set the lancet deep enough.

We have a doggy bed in the den & I have all the gear there. When it's time she actually runs right to it since she knows her meal comes right after.

I hold her head in my lap & she lets me do the test.

I use the Soft Clix pen set at 4.5 & jab according to the directions in Chris's video.. Sometimes it takes more than one attempt to get a good drop.

Good luck. You can do it!

Rick

[k9diabetes]

Sandy,

Just so you know, no one expects you to master this right away!! :)

The video of Chris and I was done after I'd been testing his blood sugar for four years!! When I first started, I had many many failed tests, drops of blood that were too small, meters timing out before I got the strip filled, and Chris bouncing around smearing the blood I did get all over the place.

Some people do get it sorted out quickly but I wasn't one of them! Chris was very wiggly at first and couldn't figure out what the heck we were doing!

Time, experimentation, and practice will tell you what works best with Zoe. Try a few times a couple of times a day and then set it aside and don't stress over it. Try again tomorrow.

Sometimes even just a slight shift in location makes a big difference too so it's all a matter of trying and seeing what works and what doesn't. There were parts of Chris' lips that would hardly bleed and others that bled really well.

You can actually do the edge of the lip or even the outside of the lip as well.

Usually the folks who test on the back test just in front of the tail right in the center of the back. And some folks actually prick two spots close together so that it forms one drop that's large enough to test.

What meter are you using?

Also, some lancing devices work better than others. I really liked the Softclix by Accuchek.

I have no doubt you will get there. Just want you to relax and not stress over it as that won't make it any easier for either one of you! Take your time and experiment and, mainly, don't give up but don't pressure yourself either!

I can remember how hard it was to get one test done the first few weeks we worked with Chris... in later years, I could fill three different meter strips from one drop of blood. All a matter of practice over a long period of time and both of us getting used to the process. And no longer being afraid about it.

Hang in there,

Natalie

[Fishslayer]

I have no doubt you will get there. Just want you to relax and not stress over it as that won't make it any easier for either one of you! Take your time and experiment and, mainly, don't give up but don't pressure yourself either!
Natalie

What she said...100%

Lucy was absolutely more relaxed and easier to work with as we both learned and I became more relaxed myself.

Dogs are incredibly tuned to our own stress levels.

Rick

[Margaret Boyle]

Good for you Sandy I might get that tip from you about the rear end
where exactly do you do it? The electric razor or clippers do not shave it
enough when I tried Lucy's tail I used an ordinary razor soaped it first then
shaved. :)

Congratulations ;)

Hi Sandy,
I was exactly like you at the start, did you do the small pads the way I explained to you? I use the one touch ultra soft pen blood sampler set at number 5 and I get a good drop of blood And I use the ultra soft lancets
they are 28gague. Try not to get stressed out you will find a place.If I run into problems I will try Lucy's lip again she is not keen on it but I would just put a lower setting some parts of the lip are better than others. Lucy does not even flinch with the small pads on the front legs. Make sure you have not any fur near the area you are testing as this can mess up your drop.
Keep trying Sandy not constantly as you do not want to put her off. Don't
give up Sandy forget about it for a couple of days relax and try again.
You will definately get there ;)


Lots of Luck :)

[Zoe's Mom]

today, using the squeezing while I pricked and doing a double prick, I was successful getting blood 4 times in a row at random times when I thought of it! :) Thanks for all your help in doing this. So, here's what I got:

4/2/09 gave 12 units at 7:00 a.m.

9:52 a.m. 412 BG
10:53 a.m. 419
12:02 p.m 429
4:52 p.m. 415


She started on Humulin N on sunday evening...so has been on it for 4 full days now. All her numbers were quite high today, and I am wondering if I need to wait more a few more days for her body to adjust to the new insulin, and/or should go ahead and do a full curve and/or increase her dosage a unit simply based upon these numbers.???

[k9diabetes]

Happy happy happy happy dance!!! I knew you would figure out a way!! :)

[Zoe's Mom]

Hi All,
So, I've been checking Zoe's BG's with ease. :-) On March 31 we converted her over from Vetsulin to NPH. We started her on 12 units, and I have been inching her up slowly. Anyway, on 12 units, she was in the 400's all day. On 4/20 I upped her to 15 units (after increasing her slowly). On 4/21 I did 2 random checks and at 11:30 she was at 304 and at 2:00 p.m. she was at 262. She was out of the 400s, I did a full curve today 4/28. Here's what I got:

15 units NPH at 7:15 a.m. and 1 1/3 Cup Purina DCO & 1 milkbone
8:00 a.m. 380 and 388 (2 strips since I got enough blood)
9:00 a.m. 327
10:00 a.m. 387/458/428 (which number is probably the real one?)
12:00 p.m. 442
1:45 p.m. 295
3:30 pm 384
5:30 p.m. 324

It seems odd to me that she continued to go UP for 5 hours after her morning shot. I thought NPH was supposed to start to work within 1 - 3 hours. And then her low of 295 was obviously not low enough. But with the 3:30 reading of 384 and 5:30 reading of 324 at least it appears to be working a substantial period of time and I won't have to fool with a 3rd shot like I was worried about :). So, other than increasing her a unit (which I will be doing), any thoughts on anything else I can do with help her curve look better?

Also, at the 10:00 a.m. reading, since I had extra blood and the reading was higher than the previous one, I used 2 more test strips and got very divergent results. I know there's a certain margain of error, especially when the numbers get higher, but how do I really know what number is closest to reality?

[eyelostit]

Hi Sandy,

Is Zoe still on the 1 1/3 C of DCO, any change in diet? Have you ever tried adding some green beans or brocolli to Zoes food. i never had much luck with DCO, it raised Niki BG too high, that was a 9 month learning experience at first dx for us.

I don't have much exp. with cushing and diabetes both, I'm sure a few other members will soon be here and can help a little bit more.:)

[peggy0]

Hi Sandy

Even though it continued to go up, it didn't really go up by much. Forbins BG stayed in the 300's until I started changing his food. He is diabetic, no cushings, but does better taking away some of the carbohydrates and adding protein. I started with 1/4 cup decrease in carbs (like dco) and added 1/4 cup of high protein. Buffalo blue wilderness, orijen are two that are high protein. It brought him down at least 50 points.

[Zoe's Mom]

Hi Sandy,

Is Zoe still on the 1 1/3 C of DCO, any change in diet? Have you ever tried adding some green beans or brocolli to Zoes food. i never had much luck with DCO, it raised Niki BG too high, that was a 9 month learning experience at first dx for us.

I don't have much exp. with cushing and diabetes both, I'm sure a few other members will soon be here and can help a little bit more.:)

She's been on the DCO since about 2 months after initial diagnosis, and way back when, it did bring her down substantially. But that was before the cushings and everything went crazy.... So maybe that is part of the problem now.

So maybe I should just up her one more unit to 16 and give it a week, and if she's still high which I suspect she will be, slowly cut-down the DCO and supplement with Buffalo Blue Wilderness that peggy suggested & see what happens.

I do give Zoe some green beans in the early evenings if she is starving & refuses to wait until her designated feeding time (ie barking at her food bowl & won't shut up) to hold her over, but haven't given them to her at other times of the day. Other than filling her up and giving her some extra vitamins, how would supplementing her more often affect her BG's???

[eyelostit]

She's been on the DCO since about 2 months after initial diagnosis, and way back when, it did bring her down substantially. But that was before the cushings and everything went crazy.... So maybe that is part of the problem now.

So maybe I should just up her one more unit to 16 and give it a week, and if she's still high which I suspect she will be, slowly cut-down the DCO and supplement with Buffalo Blue Wilderness that peggy suggested & see what happens.

I do give Zoe some green beans in the early evenings if she is starving & refuses to wait until her designated feeding time (ie barking at her food bowl & won't shut up) to hold her over, but haven't given them to her at other times of the day. Other than filling her up and giving her some extra vitamins, how would supplementing her more often affect her BG's???

I'd try the lil bit of food change before you change the insulin dose, if you do both it'll be hard to tell whats working or whats not. If you do a curve, also doing both food and insulin change it will cloud that.

Hope this helps.:)

[Zoe's Mom]

I've been converting Zoe over to Buffalo Blue Wilderness food for several days with no change in BGs yet. This morning, I awoke to dog vomit all over the floor :mad: which was clearly the entire contents of her meal last night. I checked her BGs and she's at 354. She won't eat anything. I would think I shouldn't give her the normal amount of insulin? But by how much do I reduce the dose????

[k9diabetes]

I'm sure you made a decision by now... I knew I could give Chris 1/3 to 1/2 his insulin without food. With BG of 354, I'm sure 1/4 to 1/3 of her dose would be okay - I'd still want to be around to monitor her.

This is something you can experiment with when it happens until you know how much of her dose she can have when she doesn't eat. Start out convservatively with a very small amount of insulin and see how it goes.

[Margaret Boyle]

I've been converting Zoe over to Buffalo Blue Wilderness food for several days with no change in BGs yet. This morning, I awoke to dog vomit all over the floor :mad: which was clearly the entire contents of her meal last night. I checked her BGs and she's at 354. She won't eat anything. I would think I shouldn't give her the normal amount of insulin? But by how much do I reduce the dose????

Hi Sandy,
I have not spoken to you for a wee while I see you are doing great with the
blood testing I told you it would get easier Lucy lets me do the inside of her lips no bother now it gives me more options especially when I do a curve ;)
How did you find out Sandy that Zoe had Cushings? What were her symptoms.
Lucy was tested when she was in the hospital for 4 days but they said she did not have it. That was over a year ago and we are now on new insulin and still not regulated. :rolleyes: Maybe one of those days. I am also going to change Lucy's food but after our holiday I do not want any problems.

LOL

[Zoe's Mom]

Hi Margaret & Lucy,
Zoe was fairly well regulated with diabetes for one and a half years, and then suddenly she started losing weight, becoming lethargic & vomiting and her BGs were waaayyy out of control then no matter how much insulin she got. Her head and ribs and shoulders were very very bony, but her belly remained full. So they did a low dose dex suppression test and I think ATCH test and diagnosed it.

I was actually thinking about the cushings thing yesterday as one of my best friend's has a jack russell who just got diagnosed with diabetes. I just saw him and noticed he looked like Zoe did when she was diagnosed with cushings. So, she's gonna bring him back to the vet and ask for a cushings test.

Hope you are well! Sandy

[Zoe's Mom]

I'm sure you made a decision by now... I knew I could give Chris 1/3 to 1/2 his insulin without food. With BG of 354, I'm sure 1/4 to 1/3 of her dose would be okay - I'd still want to be around to monitor her.

This is something you can experiment with when it happens until you know how much of her dose she can have when she doesn't eat. Start out convservatively with a very small amount of insulin and see how it goes.


Thanks. Yeah, I made a decision and gave her 10 units of insulin instead of her 15, and got her to eat about a teaspoon of canned food, and figured that was safe since she's been high even on the 15 and I've been watching her all day and she hasn't dropped below 321. :)

Now I am just scratching my head trying to figure out what made her vomit. She was acting funny last night, and I thought she wanted a snack and gave her greenbeans (which she has had multiple times). I gave my other dog a handful of the greenbeans too. I think, but am not sure, that both vomited. So maybe something was wrong with the beans. But, she was acting funny before the beans, so maybe the new food isn't agreeing with her and it is a coincidence that my other dog may have vomited too (the other one vomits every few weeks regardless of what she eats). Hmmm.... maybe I'll just head back to the DCO .....

[eyelostit]

I think I'd go back to the DCO also, you did the food change gradually taking away the DCO, I wonder about the ingredients in the new food you tried.
I hope things are better today.:)

[Zoe's Mom]

She seems absolutely fine now, so I am assuming it was the food and will stick with DCO and up the insulin a unit for now. Also, just found out today that the reason my other dog has been "off her feed" for the last while is she has Addisons. I just can't believe my luck...one diabetic cushionoid schnauzer and another with Addisons which I understand is just the opposite of cushings. How bad can our luck be?

[eyelostit]

She seems absolutely fine now, so I am assuming it was the food and will stick with DCO and up the insulin a unit for now. Also, just found out today that the reason my other dog has been "off her feed" for the last while is she has Addisons. I just can't believe my luck...one diabetic cushionoid schnauzer and another with Addisons which I understand is just the opposite of cushings. How bad can our luck be?

Aw.. I know what you mean Niki was diabetic and my Akita got cushings about about 3 yrs later. I never had pets with these diseases.

[Zoe's Mom]

Hi Everyone,
I have a question. Zoe just had to have surgery on tuesday to remove a giant cyst that was rupturing. She's currently on 18 units NPH 2x a day, 50 mg Trilostane (for cushings) 1x day, 50 mg tramadol (2x a day but today is the last day) for pain, 100 mg simplicef 1 time a day (antibiotic).

She's actually doing o.k. after the surgery itself. It looks like the incision itself might have a small infection at one end, and I've been treating it with peroxide. I'll bring her into the vet in a day or so if it doesn't clear.

Ever since I brought her home from surgery, no matter where I give her the injection, it hurts. The incision runs from her shoulders and down her back about 5-6 inches...so quite a bit since she's just a mini-schnauzer. I used to inject her at the scruff of the neck, but because of the swelling there & yelping, I tried to get extra skin at her thigh/leg area when she is laying down. She still yelps. I've tried making sure the insulin is room temperature. I've bought smaller cage needles. But nothing seems to work. Sometimes she yelps when the needle goes in, sometimes she won't yelp until the insulin is going in, and sometimes it is a full 3 seconds after I have already completed the injection before she yelps. Today, I tried the scruff of her neck again because the swelling is down, but she had pain too. She jumps when she yelps, so I have to take the needle out.... so she ends up getting pricked a few times for each shot now. This is giving me lots of anxiety, and I am sure she is picking up my anxiety as well.

I am wondering if maybe the pain meds she is on are having some weird effect on her nervous system or something? I would have thought though that her pain would be lessened during injections due to the medication though. Please if anyone has any ideas what could be causing this or what I can do to fix it, please please let me know so I can spare poor Zoe further pain. She's already gone though enough this week without having to have me torture her two times a day. Thanks!

[We Hope]

Sandy,

Not sure why Zoe's having such a tough time with the injections, but know Dolly (eyelostit) had a period of tough times with Niki's shots. This helped her:

http://www.childrenwithdiabetes.com/pumps/relatedproducts.htm

"Holding an ice cube against the skin for several minutes can also numb the skin."

We tried this a while back for someone's dog who was having problems when he got his shot. It takes a little longer with a dog because you need to hold it there long enough for the cold to get past the fur. Our "test dog" was a samoyed, so you know how thick that type of fur is. It worked fine. ;)

Maybe this can replace the OraGel/Anbesol--nothing but frozen water. :)

Kathy

My understanding is that the ice cubes got them both over the "bump" and Dolly no longer needs to use them for Niki's shots.

HTH!

Kathy

[Zoe's Mom]

Hi Kathy,
I tried ice and she still yelped. :confused: I know it was on long enough to numb the skin because my fingers were frozen. Of course I'll try it again tonight & hope for better luck.

I vaguely recall reading that Chris developed an allergy to NPH, and was wondering if this might be that type of reaction? She isn't having any other symptoms besides pain from the insulin though..... Sandy

[We Hope]

Sandy,

According to the leaflet which comes with the vials, skin reactions can occur in people.

FDA is in the middle of a site re-do, and the normal links for pages aren't working in plenty of spots. This comes from the Internet Archives:

http://web.archive.org/web/20061010214819/http://www.fda.gov/cder/foi/label/2003/18781scm074_humulin_lbl.pdf

This is a copy of the Humulin N leaflet--page 6-"Local Allergy".

You can run into issues with the protamine suspension and/or the preservatives in the insulin, phenol and meta-cresol. Chris had issues with the protamine suspension of NPH; the R he was switched to contains meta-cresol as a preservative, so he sure didn't have problems with that. We had issues with all 3 when going from pork Lente to pork NPH.

I bumped up the "reactions to NPH" thread for you--I don't see anyone reporting pain at the shot, but that doesn't mean it can't happen.

Hope you can find a way to make Zoe's insulin shots stop hurting!

Kathy

[Zoe's Mom]

Thanks, I hope I figure it out soon too! The vet is stumped too......

[k9diabetes]

Skin reaction is a possibility but I would think that would have happened sooner.


Sometimes she yelps when the needle goes in, sometimes she won't yelp until the insulin is going in, and sometimes it is a full 3 seconds after I have already completed the injection before she yelps.


The fact that it happens even several seconds after the injection makes me think it's not the injection itself that's the problem. Maybe she's just in pain and uncomfortable and tired of being handled and poked so much and just doesn't want to deal with it right now.

My cat Gus, for example, has an understanding with the vet. The vet does what he needs to do until Gus says "enough" and then the vet quits and leaves him alone!

I know that doesn't sound very helpful but if it's a stress issue then it may be temporary and once she feels better she will relax again or you may be able to find a way to reward her for her injection.

Consider doing a few fake injections, in part to see if you can sort out whether it's actually the injection or whether it's a stress/emotional issue.

If it's a stress issue, I think you will see it happen if you use something like a capped syringe or the end of a pen to touch her skin like you would with the needle.

I'd start by holding her the way you would for an injection, tenting her skin the way you would for an injection, but just hold the end of a pen or a capped syringe against the skin and try to duplicate the time held there and the pressure.

Pain could still be an issue though. But you will start to see if it's the actual injection or the handling, tenting, etc.

You could drop one action at a time and see if the yelp goes away. So first, still act like you're giving her an injection but don't tent the skin.

Then touch her with the pen or capped syringe without holding her or restraining her.

And try these various things in different places on her body. Chris, for example, didn't particularly like injections on his right side. He was always more uncomfortable with them on that side. There can be quirky reasons that could be the cause.

When and if the yelping stops might help narrow down the problem.

If she yelps even if you just touch her skin with the end of a pen, she's either in a LOT of pain or it's a stress issue and she just doesn't want to do it.

With that big of an incision, she just might not want you messing with her skin! Which I know is hard but it should also be temporary. Could be any tug on it causes some pain from the incision - I just had a root canal and have some very sore gums around that tooth and it takes almost nothing to make it throb.

I do hope that with some time to heal she will be more cooperative and not make you feel so bad!

Natalie

[Zoe's Mom]

Thanks Natalie. This morning she flinched, but didn't yelp, which is an improvement. I will try the capped syringe later today and see her reaction.... hopefully she is just overly sensitive from the surgery and I will continue to see improvement. I'll keep you posted!

[Zoe's Mom]

So I tried using a capped syringe, and she didn't flinch...she proudly stood up and wanted her treat! So, feeling brave, I tried to give her the real shot.

Not so good. I have tried at least 15 times tonight to get that darn shot in her and she always yelps and jumps up. Tonight she's yelping the second the tip of the needle makes contact with her skin, so it isn't making a difference whether the insulin itself gets into her system. I also tried applying ice first, which didn't work. I managed to get 5 of her 18 units into her once before she jumped crying, but haven't had success with the rest yet. I have a benzocaine spray here and was thinking that it might help numb the area better than ice so she won't feel it coming. But other than that, I am stumped.

[Zoe's Mom]

Hi again,
Last night my husband finally got all her insulin into her while I physically restrained her and she cried. :(

I went out & bought itty bitty syringes (31 gage 5/16 mm) and yummy twisty chew treats which Zoe LOVES and gave her quite a while to enjoy the chewy. I snuck up behind her (thank goodness she's blind!), and gave her shot to her in her thigh. She didn't even notice! I'll try the same thing tonight. Keep your fingers (and toes) crossed that it goes well! :)

[k9diabetes]

Good job!!

I think she will get better after she's had time to recover from the surgery. That's an awfully big incision and I'm sure it's tender. I had a plain old root canal over a week ago and the gums got banged around and have been very sore. I can just imagine what that big old incision would feel like.

Natalie

[Zoe's Mom]

I wanted to give you a quick update on Zoe. She's taken the last 5 shots without complaining. :) So, I guess it was all related to being sore from her surgery. And she's feeling so much better. Today I had to stop her from playing with our new puppy -- the vet said to keep her calm etc...for 2 weeks after surgery and we have 2 days to go. But I was thrilled she felt frisky enough to play!

I didn't mention before that we lost our other schnauzer Sadie last month due to Addison's disease & probable kidney cancer. She was Zoe's companion for Zoe's entire life, so Zoe was quite depressed. We have a 14 week old schauzer puppy now to keep Zoe company, and Zoe seems happy again.

[eyelostit]

I'm glad the shots are better, I had a time aways back, no doubt Zoe was feeling " I had enough of all of all this" for awhile, now Zoe is feeling better and the shots are not upsetting her anymore.

I know you're glad that is over. ;)

Dolly

[k9diabetes]

I'm so happy to hear that Zoe is feeling better!!

My condolences, though, on the loss of Sadie... it is really hard. I just went to a park today, unwillingly, that we often took Chris to that last couple of months when he was so frail. Our dog Jack loved the park but all I could do was cry. Godspeed to Sadie.

Natalie

[eyelostit]

I'm so sorry about Sadie

[Zoe's Mom]

Hi Everyone,
Last thursday night, Zoe came down with pancreatitis. She was vomiting for 12 hours, and we got her into the vet on friday morning. She was hospitalized through the weekend. Now, we have her home and are feeding her every 2 - 3 hours with two to three tablespoons of rice with cottage cheese or chicken. She has not vomitied since she came home.

I have struggled to get Zoe's BGs down forever. It just seemed like I was barely keeping up with it. Last wednesday, after she had been moved up to 19 units NPH 2 x a day, I checked her a few times that day and had terrific readings (for her): 265, 331, 175. So, then the pancreatitis happened.... The vet reduced her to 10 units while she is on this limited weird eating schedule. We assumed her BGs would be through the roof because while she isn't eating a lot, she is eating often, and it is high in carbs. The vet called today to check on her, and so I checked her BGs before he called. She had an 86. It was just shocking.She had eaten the equivelant of 9 tablespoons rice with chicken over the previous 4 hours. She has never been that low in the 2 years since she was diagnosed.....even on thursday night where she was vomiting all night she only got down to 125 and that was with a full 19 units in her system. The vet was very surprised. He said before speaking with me he was thinking we'd have to inch her back up to 19 relatively soon..... He is now thinking that somehow the pancreatitis may have re-started her pancreas???? Has anyone heard of such a thing ever happening? I'll let you know what happens when I check her tonight. The vet told me to give her some maple syrup on some rice right now since we are headed out for a few hours. :confused:

[ravenecw]

Hi Everyone,
Last thursday night, Zoe came down with pancreatitis. She was vomiting for 12 hours, and we got her into the vet on friday morning. She was hospitalized through the weekend. Now, we have her home and are feeding her every 2 - 3 hours with two to three tablespoons of rice with cottage cheese or chicken. She has not vomitied since she came home.

I have struggled to get Zoe's BGs down forever. It just seemed like I was barely keeping up with it. Last wednesday, after she had been moved up to 19 units NPH 2 x a day, I checked her a few times that day and had terrific readings (for her): 265, 331, 175. So, then the pancreatitis happened.... The vet reduced her to 10 units while she is on this limited weird eating schedule. We assumed her BGs would be through the roof because while she isn't eating a lot, she is eating often, and it is high in carbs. The vet called today to check on her, and so I checked her BGs before he called. She had an 86. It was just shocking.She had eaten the equivelant of 9 tablespoons rice with chicken over the previous 4 hours. She has never been that low in the 2 years since she was diagnosed.....even on thursday night where she was vomiting all night she only got down to 125 and that was with a full 19 units in her system. The vet was very surprised. He said before speaking with me he was thinking we'd have to inch her back up to 19 relatively soon..... He is now thinking that somehow the pancreatitis may have re-started her pancreas???? Has anyone heard of such a thing ever happening? I'll let you know what happens when I check her tonight. The vet told me to give her some maple syrup on some rice right now since we are headed out for a few hours. :confused:

Wow, I'm not sure if I should say congrats if that is the case or what... I will just say I hope for the best, amazing story - please keep us posted on this.

[Margaret Boyle]

Hi Sandy,
I was sad to hear about Sadie and I know Zoe will miss her you will have a lot of lovely memories.

I am also sorry that Zoe has had a bout of pancreatitis. I do not know about the pancrease working again they will know better about this. I do hope this is the case. :)

As you know Sandy the Schnauzers are very difficult to regulate but you sound as if you had some good numbers with Zoe and I do hope and pray this continues for you. They are great wee dogs I love my Lucy to bits.:D

We are still having ups and downs but I think we are getting somewhere now
Lucy will be 2 years dx at Xmas.;)

The new pup will certainly help Zoe to feel better another wee companion for her that is lovely Sandy.:)

Hugs to you all.

[We Hope]

Sandy,

It doesn't happen often, but it CAN happen:

http://www.vetinfo.com/ddiabt.html

Diabetes with rebound hyperglycemia

"Diabetes that starts out in conjunction with pancreatitis can be really hard to deal with at first since there are other pressures on the hormonal system from the pancreatitis. In addition, once in a while a dog with diabetes in conjunction with pancreatitis will suddenly experience a resurgence in insulin producing capability and a sudden "recovery" from diabetes. If you aren't thinking about that possibility it can lead to insulin overdosage."

Even though Zoe has you going in circles regarding her low bg's, I'm glad to hear she's feeling better from the pancreatitis bout! :)

Kathy

[Zoe's Mom]

Thanks Kathy. We just got home from being out. I fed her 3 tbs of rice literally covered with maple syrup before leaving at the time of my last post. She is now at 56. Wow. She'll be thrilled for more maple syrup..hopefully it doesn't restart the pancreatitis though.

[Zoe's Mom]

The saga continues. Last night at shot time she was at just 125, so we skipped the shot. She had 3 meals between the shot and now when I checked her and she was at only 260 -- which used to be a good number for her on 19 units. So, I fed her and just gave her 5 units since 10 appeared to be way too much yesterday. Should be interesting to see how this works out. I am convinced that her little pancreas is now working again...granted it is not working perfectly, but I am amazed nonetheless.

[k9diabetes]

It would be great to think, too, that maybe there's been some long simmering chronic pancreatitis that you've managed to get under control!

Natalie

[Zoe's Mom]

Who knows what is happening. Yesterday I gave her just 5 units and she was down to 99 by noon (just 10 pts above where she was the previous day when she later dipped to 56)...and we were heading out for a few hours so I gave her some rice with maple syrup. So, at 3:30 when I came home she was at 331, and it went upwards from there. We had a "HIGH" at shot time, and I gave her 5 units again. This morning she was at "HIGH" again at shot time, so I upped her back to 10 and will watch closely today. I am starting to think that maybe the inflammation in her pancreas somehow caused it to secrete insulin, and now that the inflammation is subsiding so is the insulin production. And if that's the case, I'll need to move her back towards her 19 units in the near future once she gets back on regular dog food. The vet says she should be on I/D not Purina DCO which she was on. Do you think I should increase the insulin slowly one unit at a time over a period of weeks again-- or, assuming I keep getting "HIGHs" bump her up 2 units or more at at time or something since that's where she was before?

[k9diabetes]

I would raise it in increments because it's still possible that she needs less (or more) insulin now than she did.

I am personally doubtful about the pancreas producing insulin again... there are other potential explanations. One is an Addisonian type reaction - a drop in her production of cortisol, either because the adrenal gland didn't function properly or because the signaling hormones weren't being issued properly. Low cortisol makes the body very sensitive to insulin.

Another possibility is that some inflammation was temporarily reduced and now it is back.

It's possible the pancreatitis, at least in chronic form, is coming back too.

It's possible that the pancreas did produce some insulin and, in the process, incited an attack on the last of the beta cells.

I don't think we can easily know what is happening with her insulin use so I'd just test and raise the dose up slowly.

Also check to make sure there's no chance of the high readings being caused by rebound.

I sure sympathize with how frustrating and confusing this is! So many processes in the body impact blood sugar that sometimes I think it's a miracle we get any regulation at all!

Natalie

[Zoe's Mom]

I didn't even think about the cortisol. She has cushings and is on Trilostane. Perhaps with all this she is getting too much trilostane now. The crazy thing is I just checked her and she's at 51. More syrup for her. This is getting to be a habit I am sure she likes. :)

So I guess I should drop down to 5 again but stay there for a few days and watch her bgs closely in the afternoons?:confused: Or since I gave her 5 last night and she woke up "HIGH", maybe the HIGH was actually a rebound from going too low during the night?? So then maybe I should go to 4 instead?

We probably should get an ATCH test done (at about $300 a pop) on her to check the how the cushings is doing. Unfortunately, after the $2k we just spent on her this weekend for the pancreatitis (which brings the grand total of care up above $10k for the last 2 years) my husband says no more vet visits for Zoe & that we'll just do supportive care from home. Hopefully I'm able to keep her BGs at a reasonable range and do our best to prolongue the length as well as quality of her life.

[k9diabetes]

Wow! I didn't know (or at least remember) that she has Cushings!

Yeah, I would try to do some mid-day checks and see if this is actually rebound.

Are you a member of the Cushings forum? www.k9cushings.com (http://www.k9cushings.com)

They could advise whether the trilostane might need to be reduced because of what else has been going on with her.

Pancreatitis is very expensive to treat... I have been grateful that Chris did suffer from that as he had enough expenses as it was.

Natalie

[Zoe's Mom]

Thanks Natalie. I just posted over there & look forward to seeing if anyone has any ideas. :-) Sandy

[BestBuddy]

Hi Sandy,

Cortisol levels and glucose levels are definitley tied in together. I found that before we started trilo Buddy's insulin (caninsulin) had to be increased and then when the cortisol levels dropped we needed to decrease the insulin. Buddy had an addisons episode and went into remission from cushings and caninsulin seemed to stop working. His BG levels would drop for about 4 hours and then rise until next meal and injection. It was like the insulin was being used up too quickly so we changed to Humulin N and BG levels were back to normal.

Buddy had already been diabetic for 4 years before the cushings and it seemed strange that after the trilo or low cortisol that the caninsulin stopped working for us.

How much does Zoe weigh? The other thought is that 10 units is too much and 5 too little so maybe something in the middle 6-7 may be an easy answer.

Jenny

[Zoe's Mom]

Hi Jenny,
She's about 22 lbs right now. I just checked her and she's back up to 373..but she had a LOT of syrup this afternoon. Hmmmm.... Of course, even if I figure out where she's good for THIS week (not too high or low), starting Sunday she comes of the rice/chicken/cottage cheese diet and goes over to ID, which should mess up the numbers again. :D

[BestBuddy]

Yes the diet change will muddy the waters again. Are you going to make the change gradually over several days? I would gradually add the id while dropping the chicken and rice so it is not too much of a shock. The rice could be a part of the problem, Buddy was always all over the place on rice whether white or brown. Zoe's last ACTH numbers looked good, how long ago was that and have you planned another, although expensive it is the only way to tell if cortisol is contributing to what is going on.
Jenny

[ladysmom06]

Hi Sandy,

Sorry to hear that Zoe is having some problems. I forgot that Zoe also has cushings. Lady had cushings and diabetes but never had pancreatitis. Marianne's dog Pebbles had all three. I sent Marianne an email about Zoe. Hoping maybe she can help you. Hugs to you and Zoe.

[Zoe's Mom]

We'll definitely slowly add in the ID. I'll probably start doing that tomorrow. The 4 units I gave her last night seemed ok. She woke up at 326. So we did 4 again this morning and I'll check her around 2:00 p.m. which is when her low should be.

The good news is that she played with our puppy for about 30 minutes this morning so she's finally feeling like herself again.

As for ATCH test, we can't do any more tests on her...it is just too expensive. :( Her ATCH numbers had been relatively stable since diagnosis 1.5 years ago, so I will just hope for the best and that if her cortisol levels are getting higher from the pancreatitis that they'll level out soon.

[k9diabetes]

Just wondering how Zoe's doing today.

Natalie

[Zoe's Mom]

thanks for asking!

Since yesterday I've been easing her back to kibble from her rice & chicken or cottage cheese, so she's had 3 meals with about 1/4 cup of ID in them. And she's been consistently in the 400s yesterday and today. She was on 4 units yesterday morning, and then I upped her to 5 last night & this morning. I am thinking to up her to 6 tonight and 7 tomorrow and hold there for a few days & do a curve, since she'll be getting bigger & bigger meals with more kibble and since she's in the 400s now. Do you think going to 7 tomorrow's too drastic given the fact that before this craziness all started she was on 19 units 2x day?

[k9diabetes]

You know, it's all kind of up for grabs at the moment between her very different response now and the change in food. A two-unit increase seems reasonable and as long as you're keeping an eye on her you can respond if there's a problem.

I wonder if you could get just a baseline cortisol test for a reasonable amount of money. Skip the stimulation and the post stim test and just see what her cortisol levels are right now. Maybe that wouldn't be too expensive.

That would at least tell you whether her baseline cortisol is in some normal range.

There are still other possibilities, like maybe she's had longstanding inflammation in the pancreas that was raising her blood sugar.

Has her weight changed?

I'm trying to think of other things that might affect her trilostane dose...

Natalie

[k9diabetes]

Thought I'd post this here as well, regarding testing for pancreatitis...

Here's a bit of information on the test for pancreatitis:

IDEXX: http://www.idexx.com/animalhealth/laboratory/speccpl/

Texas A&M: http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml

Interesting note in the Texas A&M GI lab material:

Finally, we believe that there are certain dogs that should be checked for possible chronic pancreatitis regardless of any clinical signs. Currently, we believe that any dog treated with potassium bromide and any miniature Schnauzer that presents with vague clinical signs should be tested.

Apparently there's some concern about mini Schnauzers and chronic pancreatitis!

If anyone is interested in following the Cushings discussion about Zoe, her thread is here:
http://www.k9cushings.com/forum/showthread.php?t=1051

[Zoe's Mom]

I just got home from being out for a couple of hours, and after feeding her some dinner, I noticed a spot on the carpet indicative of Zoe having vomited her snack of 3 TBS rice with 1 TBS kibble while I was out. She seems to feel fine otherwise. Called the vet. They don't seem alarmed. But said tomorrow we are back to square one feeding even smaller meals again with rice & chicken. :( I haven't even checked her BG tonight, throughout today she was mainly in the upper 200's on 6 units. I gave her 4 tonight just in case she vomits again..... :eek:


Sandy and Zoe

p.s. wouldn't it be great if there was a function where I could post to both this board and the cushings board in a single click?

[Dollydog]

Hi,
I posted to you on the Cushings forum and will be back later to give more details. I have to check her journal....
Jo-Ann & Lady :)

[Zoe's Mom]

I wanted to give you a quick update on Zoe. She's not doing well. I do have her diabetes relatively stable in the 200's on 6 units 2x a day. She isn't tolerating the canned food well, and I've been homecooking for her. But she is losing weight and has no energy. She's skin and bones-- down to 20 lbs from 26 lbs. If she eats more than 1/4 cup at a time, she tries to eat grass so I know it bothers her tummy. So I feed her a couple of tablespoons almost hourly. It just breaks my heart to watch her waste away. I do fear we are finally at the beginning of the end for our sweet Zoe, and that after two and 1/2 years of fighting for her life we are helpless and are slowly watching her die. I have such a stong feeling that I am going to come downstairs one morning soon, and find that she has left us. :(

[We Hope]

Sandy,

With Zoe's bg's, it looks like Cushing's isn't an issue now. But what I'm wondering is if she might not have some problems with the exocrine part of her pancreas; this is the part of it that controls digestion. When there's pancreatitis, both portions--the endocrine (beta cells-insulin) and the exocrine can be damaged.

When the exocrine portion of the pancreas is about 90% non-functional, you start seeing signs of exocrine pancreatic insufficiency. You haven't posted that there's anything wrong with Zoe's stool, but one of the signs of a problem like this is sudden weight loss; the body isn't able to properly use the eaten food.

http://petdiabetes.wikia.com/wiki/Exocrine_pancreas

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6553&Category=1005&O=Generic

With the diabetes as well controlled as it is, we have to say that isn't a factor in the weight loss. Can't definitely say this is what's wrong with Zoe, but you might want to have a word with your vet.

Hope something helps SOON!

Kathy

[k9diabetes]

Yeah... that's along the lines I'm thinking. Maybe lack of pancreatic enzymes or a protein losing enteropathy.

Also, our cat Gus started to react from his IBD to his turkey food and did better once we switched to lamb. When his IBD flares, he loses weight.

Her blood sugar being good is a good sign.

I know it is so hard when finances prevent you from exploring possibilities. Sometimes, even when you can manage to financially explore various ideas you don't find the answer. That was the case with Chris.

Maybe they can give her some enzymes and just see if that helps.

Natalie

[Zoe's Mom]

Thanks. Yeah, I'll run out to the healthfood store later today to get some enzymes for her. Yesterday I got her to eat and keep down the equivilent of 1.5 cups of food spread throughout the day, and her energy level seemed a bit better. Today I'll try to get 2 cups into her...she was eating 2 and 2/3 cups a day before this all started so that is probably part of the cause of the weight loss.

[ladysmom06]

Hi Sandy,

Just checking to see how Zoe is doing - hoping she's eating better. Hugs to the two of you.

[rhodesian46]

How is Zoe doing today. I have been reading your thread as I had a dog named Pebbles with diabetes,cushings and hypothyroidism. She was also on Trilostane. I read the bout of pancreatitis. Pebbles too had this and after the bout her insulin amounts dropped dramatically. I see that Zoe doesn't want to eat , little vomiting and lethargic. Kinda of wasting away. Iam worried about her.

I would imagine your vet explained to you what to look for as far as when to stop the trilo and to administer pred. You do have some at home right for an emergency? If a dog is not wanting to eat is lethargic, may have diarrhea then I would call the vet immediately and stop the trilo per your vets instructions. It is not going to hurt Zoe to stop the trilo for a week . This would ( if this is what is going on here) increase Zoe's cortisol level A dogs trilo amount can change at a drop of a bucket. That's is why I had to watch Pebbles so closely. Having a cush pup plus a diabetic is a challenge and a balancing act. Pebbles bg's were controlled at times but still we had situations that she had a non stimulatory ACTHS stim test and her trilo was reduced. I think Zoes last stim was last year? I think it was really low. I don't know why the vet didn't decrease the trilo.

I realize that money is an issue as it was with me at times.I do feel that Zoe is suffering by not wanting to eat and wasting away. Could you possibly go on a payment plan with the vet? Maybe call around and get a better price for the ACTH stim. I know Nat said that this probably can't be done. I would at lease try and tell them that this is the test you need. Just make sure if you decide to try to do the ACTH stim 4-6 hours post pill.That is if you still are giving her trilo. You have had an Addison's dog I really think that this is what is going on. JMO

Marianne

[k9diabetes]

How is Zoe doing? It is really hard when you have the pancreatitis issue and the question about her cortisol levels. I hope she's feeling better!

Natalie

[Zoe's Mom]

Hi Natalie,

I am saddened to share with you that Zoe died this morning. The pancreatitis from July never resolved and she again was vomiting with diaharrea yesterday, and was in horrible pain. The vet did say that the end of Zoe was really the end of an era since she was such a great dog, and he commended me on my efforts over the past few years. I wanted to thank-you for all of your support in this journey with my sweet pup. :(

Sandy

[Patty]

Oh Sandy,
I am so sorry to hear this. What a road you and your sweet Zoe have been on.
Will be thinking of you and praying for you in the days ahead.
Patty

[ravenecw]

Oh no :( I am so sorry, I know how you must feel....

[k9diabetes]

Sandy... I'm so very sorry to hear this. You have been trying so hard for the past few weeks to do whatever you could for Zoe and I know she felt your love and care in her soul and had a wonderful life with you.

If you would like, we would be honored to have Zoe's story in our Stories forum - anything you want to write about her... It is always a privilege to get to know "our" dogs better.

Godspeed to your little girl,

Natalie

[ladysmom06]

Sandy,

I am so very sorry for the loss of your sweet Zoe. You were a great mom to her and Zoe knew how much she was loved. My deepest sympathy to you and your family.

[Margaret Boyle]

Sandy,
I am so sorry to hear about Zoe, you were a great Mum to her and loved her very much and your wee treasure knew this.

I know you will be hurting very badly Sandy and my heart goes out to you.
Schnauzers are great wee dogs and have lovely characters, you will treasure all your lovely memories you had with her.

This has upset me tonight as I know how you will be feeling, I just wanted you to know you are in my thoughts and prayers.

Hugs to you and your family Sandy.

[Fishslayer]

Awwwwww..so sorry to hear of Zoey's passing. She'll be waiting at the Bridge.

R.I.P. sweet Zoey.:(

Rainbow Bridge

Just this side of heaven is a place called Rainbow Bridge.

When an animal dies that has been especially close to someone here, that pet goes to Rainbow Bridge.
There are meadows and hills for all of our special friends so they can run and play together.
There is plenty of food, water and sunshine, and our friends are warm and comfortable.

All the animals who had been ill and old are restored to health and vigor; those who were hurt or maimed are made whole and strong again, just as we remember them in our dreams of days and times gone by.
The animals are happy and content, except for one small thing; they each miss someone very special to them, who had to be left behind.

They all run and play together, but the day comes when one suddenly stops and looks into the distance. His bright eyes are intent; His eager body quivers. Suddenly he begins to run from the group, flying over the green grass, his legs carrying him faster and faster.

You have been spotted, and when you and your special friend finally meet, you cling together in joyous reunion, never to be parted again. The happy kisses rain upon your face; your hands again caress the beloved head, and you look once more into the trusting eyes of your pet, so long gone from your life but never absent from your heart.

Then you cross Rainbow Bridge together....

Author unknown...

Rick

[BestBuddy]

Sandy,
I am so sorry to read that Zoe lost her battle. It was a tough fight and you did her proud.
Jenny

[eyelostit]

Aw, I'm so sorry, I know how hard this this, you did your best for Zoe, you're little soldier. Maybe in time you can do a story about Zoe.


http://k9diabetes.com/forum/picture.php?pictureid=191&albumid=3&dl=1248411600&thumb=1 (http://k9diabetes.com/forum/album.php?albumid=3&pictureid=191)

Dolly

[eyelostit]

Moving to top of forum

[pgcor]

Dear Sandy - I was really, really sad to read about Zoe. I don't post often, but do follow other's posts. You are to be commended for the care you gave Zoe. So many complications, but you stood by her as I'm sure she stood by you.

I hope that very soon, you will only remember the good times and what a wonderful companion she was.


Pam

[janspack]

Hi Natalie,

I am saddened to share with you that Zoe died this morning. The pancreatitis from July never resolved and she again was vomiting with diaharrea yesterday, and was in horrible pain. The vet did say that the end of Zoe was really the end of an era since she was such a great dog, and he commended me on my efforts over the past few years. I wanted to thank-you for all of your support in this journey with my sweet pup. :(

Sandy

Sandy,

I am so sad to read this news. Zoe was blessed to have an owner like you who fought so hard for her. I know that she is now fit, happy and pain free again. It's your time now to suffer from the pain of her loss but in time, the pain will fade and the happy memories will resurface.

Run free Zoe. Take care of yourself Sandy. I'll keep you in my thoughts and prayers.

[Zoe's Mom]

I do want to thank everyone for their incredible outpouring of support. It truly warms my heart to know there are such incredible people out there. Each day has gotten better, and we know she's in a better place.

[bgdavis]

Sandy,

I'm so sorry for your loss of Zoe. She experienced a wonderful life and had the best of care. She will forever be in your heart.

Bonnie and Angel Criss