new member with questions

[mikemedic]

Hello all,
I have a 10 yr old black/chocolate lab who has DM. I have treated her for about a yr and a half now. We first started using vetsulin at the suggestion from the vet. It is very costly and just read about the fda bulletin on the regulation. I convinced my vet to let us use nph.
She was on 15 units twice daily-vetsulin. Vet suggested we start out nph at 7 units twice daily. Her BG have been high for some time. A week ago it was about 590 7 hrs after food and injection. I bumped it up to 9 units and rechecked this weekend and still around 600. I'm getting frustrated with the high BS. She is blind and we have to keep her in the garage when we are not home. She has accidents sometimes in the garage. Oh well we have done well with managing to giver her the shots and feed her every 12 hrs.

I have a few questions. The vet suggested Prescription Diet food at 3.5 cups.
I dont see where this is helping especially at BS of 600.
What are some of the foods the forum members use?

I would like to bump her NPH up to 10 and recheck here BS next weekend?

How long should I wait to increase after a high BS? Vet says sometimes it takes two weeks to regulate after an adjustment.

Just want to hear some other experiences with Diabetes Dogs. I have been in the medical field for 20 yrs, cardiology and Emergency mostly,

This forum is great and look forward to hearing from some experts on here.

Thanks

Mike

[Patty]

Hi Mike and welcome!

Most likely your dog will wind up using around the same number of units of NPH insulin. I've seen many people post that their vets are wanting to cut the dose dramatically when making the switch.

If the Vetsulin was working well, a 25% reduction in insulin would probably have been sufficient to make the switch. That would have been around 11 units so you're still under that.

If you're seeing very high blood sugar, I'd think you'd be safe to assess after 3-5 days for an increase. Natalie is the expert here and can give you some advice on that. ;) Sounds like you home test? When you get closer to the ideal dose you'll want to move slowly and perhaps in 1/2 to 1/4 unit increments, especially if you're not home during the day.

Have you done curves on your dog in the past?
What were you feeding before the switch?

Here are a couple of links on diet, insulin and meters: http://k9diabetes.com/forum/showthread.php?t=240
And one on prescription diets some have used: http://k9diabetes.com/forum/showthread.php?t=651

Again, welcome!
Patty

[BestBuddy]

Hi Mike,
I made the change from Caninsulin (our version of Vetsulin) to NPH several years ago now and it was as easy as night time Caninsulin 4.8iu and morning 4iu of NPH. At that time Buddy had been diabetic for many years so we were home BG testing and I was comfortable not reducing the units too much. I believe that a unit of insulin is a unit regardless of the brand and if you know your dog is not going to drop too low then starting low takes you back to the beginning.
Food is a very individual thing and it is important to get a food that your dog will eat every meal and one that is affordable/available to you. Low fat would be the first thing I would look for and low salt.
Jenny

[mikemedic]

All,
thanks for the quick response and the great info. I feel better already speaking with other diabetic dog owners.

I now feed her 1.5 cups IAMs weight control and 1.5 cups Prescription Diet WD.

I never had to much luck with just Presc Diet WD food. I tried an Ekanbana diet food and she had major bowel problems.

I don't have an issue trying to regulate her BS and do perform hoe BS testing via meter. I had one bad reaction with vetsulin and hypoglycemia( wasn't pretty). Vetsulin kept her BS ok but it was up and down.

After the recall of Vetsulin I asked the vet to change, still trying to get it regulated. I bumped the NPH up to 10 units and will test again this coming weekend.

She also just got over a UTI a few weeks ago, and her urine is ok now. Thats another thing, any ideas on UTI prevention other than regulating the BS.

SHe always seems so hungry and has lost lots of weight. I feel bad cause she is all bony.

Anybody have any luck with any other dry foods?

Thanks again,

Mike

[BestBuddy]

Buddy didn't have a lot of teeth for the last few years of his life but he managed to gum Science Diet Mature dry, he also ate the wet and he seemed to like it and it also worked well with the NPH.

Jenny

[Dakotapix]

Mike -- You might be changing your dog's diet too fast. I've read some recommendations that you should make food changes over a period of two to three weeks by gradually mixing increasing proportions of new to old food. It is also recommended that you add water to dry kibble and make sure that water is always available to help flush out the bladder. Her weight should start to come back slowly once you know she is regulated.

Since losing my dog last month, I've spent a lot of time studying various food recommendations. I will be giving serious consideration for my next miniature schnauzer to feeding canine products by either Solid Gold or Natural Balance. Never again for Science Diet.

All,
thanks for the quick response and the great info. I feel better already speaking with other diabetic dog owners.

I now feed her 1.5 cups IAMs weight control and 1.5 cups Prescription Diet WD.

I never had to much luck with just Presc Diet WD food. I tried an Ekanbana diet food and she had major bowel problems.

I don't have an issue trying to regulate her BS and do perform hoe BS testing via meter. I had one bad reaction with vetsulin and hypoglycemia( wasn't pretty). Vetsulin kept her BS ok but it was up and down.

After the recall of Vetsulin I asked the vet to change, still trying to get it regulated. I bumped the NPH up to 10 units and will test again this coming weekend.

She also just got over a UTI a few weeks ago, and her urine is ok now. Thats another thing, any ideas on UTI prevention other than regulating the BS.

SHe always seems so hungry and has lost lots of weight. I feel bad cause she is all bony.

Anybody have any luck with any other dry foods?

Thanks again,

Mike

[Margaret Boyle]

Mike -- You might be changing your dog's diet too fast. I've read some recommendations that you should make food changes over a period of two to three weeks by gradually mixing increasing proportions of new to old food. It is also recommended that you add water to dry kibble and make sure that water is always available to help flush out the bladder. Her weight should start to come back slowly once you know she is regulated.

Since losing my dog last month, I've spent a lot of time studying various food recommendations. I will be giving serious consideration for my next miniature schnauzer to feeding canine products by either Solid Gold or Natural Balance. Never again for Science Diet.


Hi and welcome Mike,

You were talking about UTI's and prevention.

My dog takes lots of UTI's and I use Cranberry Powder (sugar free) and this helps her some.
I give her 1/4 tsp mixed with a small drop of water through her meals twice a day.
I am in Scotland and I do not know about your Cranberry powder over there or where you get it.
There is also D-Manose that you can get over there.
I am hoping Patty will come in and explain about this as she uses it.

Also what Chuck said about the food change is correct you do it gradually,
mixing some of the new food with the old until you are on the new food completely.

Hope this helps some.

[Patty]

Mike,
I didn't think to ask before. With blood sugar in the 500-600s, I'd also test her urine for ketones if you aren't already. Do you have some KetoDiastix?

As far as your question about UTI prevention, my golden had a history of multiple infections her first year with diabetes. It really played havoc with her bg. I am a firm believer in D-Mannose powder. My dog Ali has had a couple of other infection but hasn't had a UTI since last December. Let me see if I can find Margaret and Lucy's link where I talked about it before...

Do you know what type of bacteria your dog has had? Did they do a culture? Also do you know what the pH was from the urinalysis?

Cranberry powder can be a great tool as well but it can lower pH so if your dog already has a low pH you don't want to create oxalates.

I'll see if I can find that post,
Patty

[Patty]

Here it is:

http://k9diabetes.com/forum/showthread.php?t=596&page=44 (http://k9diabetes.com/forum/showthread.php?t=596&page=44)
Margaret,
I'm sorry you have to go through another culture but definitely need to know Lucy is in the clear. I did some research online and read that one of the most common UTIs in horses is e.coli. You said your vet told you Lucy's UTI was common to horses, so I'm taking a guess here. I've read this is actually the most prevelant UTI out there for people, dogs, etc.

The cranberry powder you are using is good. The ingredient in it that helps keep the bacteria from adhering to the bladder wall is D-Mannose. D-Mannose is a simple sugar that is related to glucose but is processed differently by the body. It goes straight to the bladder where the bacteria prefer to bind to the D-Mannose than the bladder wall.

This is an excerpt from Wikipedia:
"90% of mannose ingested is excreted unconverted into the urine within 30 - 60 minutes, with 99% of the remainder being excreted within the following 8 hours. There is no significant increase in blood-glucose levels during this time." http://en.wikipedia.org/wiki/D-Mannose (http://en.wikipedia.org/wiki/D-Mannose)

I have not seen a rise in Ali's blood sugar using this. I use a combination of D-Mannose and cranberry powder for this reason:

"Although D-mannose is found in cranberries, cranberries don’t contain enough of the sugar to have the same effect. At the same time, cranberry extract contains proanthocyanidins that also prevent E. coli from adhering to the urethra and bladder.5 Cranberry extract also has a potent immune-stimulating effect. The two, when taken together, produce a beneficial synergistic effect on the urinary tract system." http://www.smart-publications.com/urinary_tract/d-mannose.php (http://www.smart-publications.com/urinary_tract/d-mannose.php)

Now when she's had an infection, I don't use this in place of antibiotics. But definitely keep her on this for prevention/help eliminate the bacteria. The holistic vet I consult with approved this dosing advice: 30mg/lb of dog twice a day. So if Lucy's 22 lbs, that's 660mg twice a day. I buy mine in powder form and measure it out.

Now the gal I told you I was corresponding with just gave me some additional information. Her dogs weigh between 19-24lbs. She gets the D-Mannose in 500mg capsules and sprinkles one over their food. During an infection, she does this 4-5 times per day. Her info came from a chat forum with a doctor from New Zealand who was part of a control group study on the effectiveness of D-Mannose. For maintenance, she does this once, last thing of the day after they've been out to potty so it stays in the bladder longer over night. The 4-5 times a day during an infection makes sense since most of it is excreted every time they potty anyway.

I've stuck to twice a day maintenance dose only because it has been working for us so far. But if she has another infection I will increase the frequency.

Do you know what the pH of Lucy's urine is? You can ask the vet what is was on her last urinalysis report. Has she ever had crystals or oxalates? These can contribute to ongoing infections. I can't seem to lower Ali's pH and it was suggested I get an ultrasound done next time we go in to see if she has some small stones/sand that is keeping her urine more neutral.

One more thing is pushing fluids. If Lucy doesn't drink much water, adding some to her food could help or encouraging her to drink more throughout the day. It's such a little thing but can really help. The gal I told you about offers her dogs a tiny bit of tuna or baby food in the water to encourage drinking at intervals during the day. I can't do that with Ali as she's pretty sensitive and her blood sugar would rise, but she does drink with all 4 of her meals and that helps a lot.

Just wanted to share what we've been through in case in might work for your Lucy.

Take care,
Patty

This is the D-Mannose powder I use: http://www.nutritiongeeks.com/d-mannose-now-3/d-mannose-now.html
This is the cranberry powder: http://www.smartpakequine.com/ProductClass.aspx?productclassid=5300&cmPreserveSource=true&cmPreserveCategory=true
Also, I can often find some coupons here since it's not inexpensive but has been well worth it http://www.retailmenot.com/view/smartpakequine.com

Ali weighs 49-50 lbs. I give her 3/4 t D-Mannose powder and 3/8 t cranberry powder in her morning meal.
And 3/4 t D-Mannose powder + 1/4 t cranberry powder in her evening meal.

I am so glad someone shared this with me last year. Hope it helps you as well!
Patty

[mikemedic]

Thanks again everyone.

I may try the science diet mature, I am experimenting with different foods and always mix.
Thanks for the KetoDiastix advice. I do check that about one a week and only see a trace so we are good there.

I will try to add some water to her food. I couldnt figure out why she has had loose bowels for the past few days. My wife threw out about 6-8 old apples for the deer. She doesn't realize the blind great nose sniffen lab can still find things even though shes blind. Don't you think she got an earfull. Maybe thats why the BS was 600?

Anyways, I will add some water to the food, check the ketones regularly and hopefully get her BS down and keep the wife away..I mean keep the wife and no throwing apples outside.

Any find some cranberry powder and or D-Mannose.


Thanks again all and I will keep in touch.

Mike

[mikemedic]

Oh and one more thing

They never cultured the UTI, Bactrim or some sort of Sulfa didnt work well, we had better success with clavamox.

I thought UTI's were caused form higher PH's ?

I will try some cranberry powder etc. Thanks again.

Mike

[Patty]

Mike,
They do have great noses don't they! Lol.

If you wind up with recurrent infections, I'd advocate for a culture and sensitivity. These days even our dogs are showing up with resistant strains and using the right antibiotic for the infection can keep 'superbugs' from forming.

With the UTIs, you're right often pH will be higher but I've seen dogs with lower pH develop them as well. I remember a Maltese on other board developed stones due to low urinary pH which cause a problem with bacteria in the urinary tract/bladder. And of course the sugar creates a great breeding ground.

Good luck,
Patty

[k9diabetes]

I'm glad you went to 10 units as I don't like to see such a large reduction in the dose when making the switch. Does she seem any better since you increased the dose?

Is the weight loss new to the change in insulins or has that been happening for a while?

Could be you need to feed more food if the problem has been long-term. Chris couldn't gain weight on WD until we fed him a lot more of it than we had been.

I hope NPH works well as her insulin dose is probably pretty large. You will save a small fortune with NPH. I personally would like to see all large dogs started on NPH, not only for the cost savings but there's so much less volume of liquid to inject.

You switched syringes, yes?

Natalie

[mikemedic]

All,
I did change syringes, been a medic for about 25 plus years and am very familiar with medicine etc as I manage a Interventional Cardiology and Radiology dept here in West Virginia.

This forum is quite interesting,

Ok as for the food. I am fighting a double edge sword? She lost alot of weight after the UTI. I was getting some meat back on her bones and boom he UTI popped up again.

So if I feed her more food then her BS is going to go up? She devours her food and is constanly hungry, and ideas on a dry food that will put wieght on but keep her BS under control....... HELP?

[peggy0]

If you add food, yes typically their BGs will go up. It's a balancing act you have to deal with by monitoring. With a UTI and an antibiotic that will be hard to do as typically their readings go haywire with antibiotics. My dog lost weight when he was first diagnosed but gained it back with his same food and the insulin being around the correct dosage. I didn't change food while I was trying to figure out the correct dosage. Its difficult to determine what caused changes, more insulin, less insulin, more food less food. i'd go after the insulin dosage being correct first then work on food :)

[Patty]

Hey Mike,
I would guess if she was gaining weight prior to the UTI your culprit is most likely high bg not allowing nutrition to the cells. Once her blood sugar is lower this should improve. Ali lost a lot of weight during her 3 month stint with UTIs. It was concerning to me as well. You said she's in the clear now right?

You could try increasing her food/calories but you're right, then you'll likely have to increase insulin even more.

How much does she weigh (by the way what's her name :))?
Is the 1.5 cups of w/d and 1.5c of Iams twice a day or total for the day in looking at calories?

Patty

[mikemedic]

Her name in mackenzie.
I had been getting her weight up before the second UTI.

I think the antibiotics/High BS caused the weight loss.

Good answer. I will get her BS regulated and yes the 3-3.5 cups of food is every feeding ( twice a day).

I am mixing IAMS weight control with the WD. I had her BS curves perfect on the food and 14 units on Vetsulin, then she caught the UTI and BS went wacko.

So the story will continue, I will do BS's soon and report back. SHe up to 10 units NPH twice daily.

[CarolW]

Hi Mike,

I've been following Mackenzie's story with interest. My Kumbi gets infections occasionally - not the usual, the UTIs - instead, his left anal gland gets infected. He hadn't had an infection for over a year, when suddenly about a month and a half ago, it hit again. This one turned out stubborn, and Kumbi was on antibiotics for 24 days. THAT cleared it up.

Meantime, though, he'd had other ills - worms, maybe giardia - his companion Kwali had that too. I had both dogs on medication for that stuff, but it turned out that Kwali had lymphoma, and we couldn't save her.

Through all this, I never got another curve on Kumbi - his last one was 31 May this year. That's a LONG time to go without a curve!

Finally got a curve the other day, and Kumbi is running high, but the curve-shape is lovely, so it's very clear we can raise the insulin dose a notch (he's on Novolin-NPH insulin) - he's short of 20 pounds, and currently at 6.75 units.

I have been feeling sure, for months, that Kumbi's been running high, and I've done a few spot checks. But my vet says, running a curve is useless in the presence of infections or when the dog is on antibiotics.

Reason? Just what you describe - lots of fluctuation in the BG levels. A few of the locum vets I've seen from time to time say the same thing - that is, no use running curves during infection or while on antibiotics.

I admit to having done some nail-chewing during this time, so when Kumbi's curve turned out so well (if high) - so STABLE - I was (and am) cheering!

NOW I know I can raise the dose, so I'm going up half a unit (twice daily), to 7.25 units, Friday. I only raise doses when I can be home to keep an eye on Kumbi, and only change dose (except to avoid hypo) when I have a curve to base my change on. This is what my vet taught me.

Wed, 16 Dec 2009 20:07:15 (PST)