New Member Jessie - Problem with shots

[ajtony]

Just wanted to say hello to everyone and tell you a bit about our Jessie. She is an 8 year old Westie, diagnosed about 3 weeks ago with diabetes and cushings disease. Three days after diagnosis she went blind with cataracts. Her b/g level 2 weeks ago was 29 (UK measurement - US I believe 522?) and she was prescribed 5 units of caninsulin once a day and 30 mg of vetoryl. I was concerned that the vetoryl dose may be too high and mentioned this to the vet (he'd only been our vet for 10 days). The next day we got a letter saying they wouldn't be our vet anymore, the reason being, 'we cannot have clients questioning our treatment of their pet'. I was gobsmacked and tried to speak with the vet but they wouldn't say anymore.

To cut a long story short we now have a new vet. Jessie is now on 2 x 5 units of caninsulin and 30mg vetoryl, and is due to go in for a 'curve' next tuesday. Her skin is very sore and itchy and she has 'lumps' all over the place (is this due to the Cushings?) but she is eating well and manages to go for a walk each day (apart from today as her rear paw is very sore and she can't walk on it).

Everything has been a bit of a blur for the last 3 weeks - we have so much to learn about the diabetes and the cushings. We are feeding her on a dry food, 'Bakers Complete' and injecting her 8.30am and then 12 hours later, after food. We are testing her urine with diastix strips and the colour has changed from the very darkest brown, to the third one up which id green (we took this as a good sign).

I will be trawling through this website and trying to do the best for Jessie.
cheers, Tony (Scotland UK)

[Jaime]

Welcome to you and Jessie! I don't have much advice to offer being that my dog was diagnosed about 2 1/2 weeks ago, but everyone on here is very helpful.

I would recommend reading back through the posts, many of my questions were answered there!

Wow, what a vet...one would think that they would want the owner's to be involved because it shows that the owner will follow the treatment plan. You are better off without them and moving on to a vet who listens and respects that you know your pet better than anyone!

Diabetes and Cushings? They may go down the Cushing road with Abby when she is better regulated but she is doing good now.

Welcome again!

Jaime and Abby

[Margaret Boyle]

Just wanted to say hello to everyone and tell you a bit about our Jessie. She is an 8 year old Westie, diagnosed about 3 weeks ago with diabetes and cushings disease. Three days after diagnosis she went blind with cataracts. Her b/g level 2 weeks ago was 29 (UK measurement - US I believe 522?) and she was prescribed 5 units of caninsulin once a day and 30 mg of vetoryl. I was concerned that the vetoryl dose may be too high and mentioned this to the vet (he'd only been our vet for 10 days). The next day we got a letter saying they wouldn't be our vet anymore, the reason being, 'we cannot have clients questioning our treatment of their pet'. I was gobsmacked and tried to speak with the vet but they wouldn't say anymore.

To cut a long story short we now have a new vet. Jessie is now on 2 x 5 units of caninsulin and 30mg vetoryl, and is due to go in for a 'curve' next tuesday. Her skin is very sore and itchy and she has 'lumps' all over the place (is this due to the Cushings?) but she is eating well and manages to go for a walk each day (apart from today as her rear paw is very sore and she can't walk on it).

Everything has been a bit of a blur for the last 3 weeks - we have so much to learn about the diabetes and the cushings. We are feeding her on a dry food, 'Bakers Complete' and injecting her 8.30am and then 12 hours later, after food. We are testing her urine with diastix strips and the colour has changed from the very darkest brown, to the third one up which id green (we took this as a good sign).

I will be trawling through this website and trying to do the best for Jessie.
cheers, Tony (Scotland UK)


Hi Tony,

Glad to see you posting and I hope things are settling down a bit:D

Marg

[Dakotapix]

You and Jessie have come to the right place, Tony. Frankly, your first vet probably did you a favor by bowing out of Jessie's treatment. My own experience with vets who treated my dog was that they welcomed my seeking knowledge about my dog's welfare. Sounds as though you'll be much happier with your new association. Welcome to this forum and good luck.

[CarolW]

Hey, Tony! A big fat welcome to you and Jessie! I ADORE Westies!

That's quite a whammy of diagnoses you have on Jessie - not fun, but I truly trust you and Jessie will do really well, because you GOT RID of at least one vet, sounds as though, maybe, two!

I'm gobsmacked, too, at the letter you received from the most recent ex-vet. How ridiculous can a vet get! It's the vet's job to work WITH the human client, regardless of what the problem is.

On the other hand, I suppose I know quite a few humans who behave in similar fashion; they seem to be people who lack confidence, and maybe that vet lacked confidence [grin]

I don't follow the Cushings forum - just too busy, and my dog doesn't have it; I'd be there if he did! But I have read some - for a few months, and wondered, too about 30 mg of Vetoryl (I think that's also called Trilostane?) for a dog Jessie's size - that is, Westie-size. How much does Jessie weigh?

Interesting that the new vet didn't drop the Caninsulin dose size when putting Jessie on twice a day. But I totally agree with the principle of injecting twice a day, rather than once. I think it makes a smoother 24-hours for the dog!

I'm starting to fall asleep at the keyboard, so will come back later - I'll be watching for your reports!

Sat, 19 Dec 2009 11:06:10 (PST)

[BestBuddy]

Hi and welcome.

It can be a tough job getting the cushings and diabetes under control but it can be done. I think i's best that you have changed vets because the only reason a vet wouldn't listen to your concerns or suggestions was if they were worried you would know more than them and over time you will be the one living with Jesse so you will know more about the diseases and her than anybody else regardless of their qualifications.

Have you had any follow up ACTH testing done to see what is happening the the cortisol levels?

Jenny

PS I don't want to overwhelm you but when you are ready (if you haven't already) head over to the cushings board for some more welcoming and support. http://www.k9cushings.com/forum/

[k9diabetes]

Hi Tony! Nice to see you hear and I am so relieved that you were able to find a vet who will work with you.

I didn't realize... and hadn't really put together the pieces... that the Cushings and diabetes were diagnosed at the same time.

I know you're participating in the CCAC Cushings group - did they feel comfortable that the Cushings diagnosis was done properly and there was no question at all about whether Jessie has Cushings?

Way too often we see a misdiagnosis of Cushings in a dog who only has diabetes because the testing can be skewed by the diabetes. So I wanted to be sure.

Re the lumps and bumps... were those present before her being treated for the Cushings and diabetes or did they start after?

If they started after, I'd be concerned about a potential allergic reaction to th one of the new meds.

Natalie

[ladysmom06]

Hi Tony,

Welcome to you and Jessie. Having diabetes and cushing's makes things a little complicated but both diseases can be treated and controlled. My little girl Lady had the two and did very well. We lost her this past March but not from either disease. Lady was first dx with cushing's and then 2 weeks later diabetes. She had diabetes when she was dx with cushing's but the vet that was treating her at that time missed the diabetes. The new vet wasn't even sure she had cushing's. Unregulated diabetes can give false positives on the cushing's tests. We tried to get the diabetes regulated and when we couldn't we repeated the tests for cushing's - we were also seeing an IMS. All cushing's tests were positive but he still wasn't sure she had cushing's. He had us switch insulin and when we still couldn't get the diabetes under control we starting treating her with trilostane. In a matter of weeks her bg's came down. Getting a cushing's dx requires more than one test. What tests were done on Jessie to confirm cushing's? What cushing's symptoms does she have? Not trying to confuse you but just want to make sure she really has cushing's. Have you joined the cushing's forum yet? Tons of info and support there. Good luck with Jessie and please keep us posted. Hugs to the two of you.

[ajtony]

Thanks Nathalie and all for the warm welcome and the advice. I hadn't even considered a misdiagnosis for Cushings. However, about 4 months ago Jessie did develop Cushing symptoms, e.g. swollen abdomen, drinking and urinating lots and eating more. She was on steroids at the time and had been for almost a year without any monitoring by the ex vet. I suggested steroid induced Cushings to the vet and we stopped the steroids immediately, and over a week or two there was a vast improvement. Then a few months later she started drinking lots again (no swelling abdomen), urinating and we noticed she had lost a few kilos in weight. I have the blood test results in front of me but they don't mean much to me apart from the fact I can read that her b/g level is high. Would it be worth posting the results on the Cushing Discussion site to see what more knowledgable people than me think.
The last two lines of figures reads:
Cortisol Base 157.3nmol/L (5.68ug/dl)
Post 678.7nmol?l (24.5ug/dl)
Jessie has had skin problems for many years but it does seem to have gone worse in last 3 weeks or so. best wishes, Tony

[k9diabetes]

Yes, please do ask the question of the Cushings group. We have seen many dogs whose cortisol tests are misleading because of the diabetes.

Our sister forum for Cushings, www.k9cushings.com (http://www.k9cushings.com), is also very skilled at evaluating the test results. I haven't really taken the time to learn to properly evaluate the results.

Your description of the recurrence and the fact that dropping off the steroids showed improvement for several months makes me think more of the steroids kicking off the diabetes at that point than Cushings and diabetics can have skin problems as well.

Of course, I don't want to tick off your new vet! I hope s/he is more flexible in approach. But I would absolutely explore this possibility with the Cushings discussions because it is a very common mistake vets make.

Usually if Cushings is suspected, we suggest treating the diabetes first since that is the life threatening condition and then see what happens with Cushings later. If the blood sugar is readily controlled, Cushings disease is very very unlikely.

So whether you can get control of the blood sugar becomes kind of a litmus test for whether Cushings is really present and often it's not.

Natalie

[k9diabetes]

I suspect, after comparing those results to Brittany's Greyson's, that they would be considered only borderline positive for Cushings.

Natalie

[janspack]

I suspect, after comparing those results to Brittany's Greyson's, that they would be considered only borderline positive for Cushings.

Natalie

Hi Tony,

I tend to agree with Natalie. I was wondering if the ACTH test was the only one carried out by the vet? To definitively dx Cushings, a second test should be performed to be certain. This is either a Low Dose or a High Dose Dexamethasone Suppression test. This takes 8 hours and you have three different readings at the end of it rather than just the two.

It's usually not considered good practice to start a dog on a chemotherapy drug such as trilostane or lysodren without doing one or other of these further tests and probably an ultrasound of the adrenal glands as well. These tests define too whether it is adrenal dependent or pituitary dependent Cushings. Something else that is really needed to be able to treat a Cushings dog properly. I've had two Cushings dogs (father and son) so have a little bit of experience with the disease.;)

In your shoes, I think I would want to have a discussion with your vet about the Cushings diagnosis. If it's at all possible, I think a referral to an internal medicine specialist might be a good idea in the circumstances.

The fact that Jesse was on Steroids was probably the cause of the initial symptoms (Iatrogenic Cushings Syndrome) as they cleared up when they were stopped. The recurrent thirst, urinating and weight loss could just as well have been due to the Diabetes.

Sorry to worry you Tony but I really do think it all needs looking into again - unless of course one of the vets did do the LDD or HDD test and got a positive result from that.

After all that, welcome to the forum - you'll get no end of help and support here.

[ajtony]

Hi Guys, We've been injecting Jessie for about 3 weeks now with 2 x 5 units of caninsulin using U-40 1ml/cc 28Gx1/2" syringes that are supplied by Caninsulin. It's never been easy and takes two of us. Lately it is getting more difficult for us. For example it took over an hour to give the injection this morning. The first syringe, the needle bent as I tried to insert it. I've read all the tips/advice on this site but I seem to be doing something wrong. I'm making the tent but most of the time the needle itself won't go into the skin. As you will all know it is very stressful and not fair on Jessie. Any advice please. Would it be beneficial changing syringes to a higher gauge. Jessie is 8yrs old, a blind Westie, also diagnosed with Cushings Disease and is a real wimp. She howls when we grab the skin to make the tent yet when the needle eventually does go in she mostly doesn't seem to feel it. Thanks, Tony.

[Margaret Boyle]

Hi Guys, We've been injecting Jessie for about 3 weeks now with 2 x 5 units of caninsulin using U-40 1ml/cc 28Gx1/2" syringes that are supplied by Caninsulin. It's never been easy and takes two of us. Lately it is getting more difficult for us. For example it took over an hour to give the injection this morning. The first syringe, the needle bent as I tried to insert it. I've read all the tips/advice on this site but I seem to be doing something wrong. I'm making the tent but most of the time the needle itself won't go into the skin. As you will all know it is very stressful and not fair on Jessie. Any advice please. Would it be beneficial changing syringes to a higher gauge. Jessie is 8yrs old, a blind Westie, also diagnosed with Cushings Disease and is a real wimp. She howls when we grab the skin to make the tent yet when the needle eventually does go in she mostly doesn't seem to feel it. Thanks, Tony.

Hi Tony,

It is Margaret from Scotland.

Some dogs do not like their skin being tented, I do not tent Lucy's skin I gently hold the skin and put it in at a flatter angle. Bevel side of tip of needle
face up.

Another tip is do not force the needle against the skin, do not hesitate when inserting the needle put it in quite quickly, then inject your insulin.

Tony you can get a U40 29G x 1/2" 1ml/cc at Pet Drugs this is what I use on Lucy.

Sometimes if their fur is long it can be difficult, I always keep Lucy's back and sides trimmed and you can do this with Westies as well, and you can also do this yourself in between going to the groomers.

I know Jessie is blind and it sometimes makes it more difficult, you and your wife are worrying about Jessie being stressed.

If you are stressed Tony this can also be picked up by Jessie.
Try and relax plenty of hugs for Jessie. Also her wee treat I use boiled turkey
cut up into small cubes about the size of my nail.

I promise you it will get easier. Try and get your 29G as this is a finer needle.

You will get plenty more tips from everyone Tony.

I was nursing and we were taught to dart the needle when putting the needle in. If you are holding it against the skin and pushing slowly this can bend your needle.

I hope this helps some.

Marg

[pgcor]

Hi Tony:

I can tell you what we did....my dog is very hyper and had to be muzzled for a while until he got used to the shots.

I'm lucky in that Pip loves to eat. I break up two diabetic cookies and put them on a plate. I make up the needle and when Pip is done eating I pick him up and put him on our counter. I put the plate of broken diabetic cookies in front of him and while he's eating I give him his injection.

As soon as he feels me tent his skin he stops eating to look at me but as soon as I'm done he goes back to eating.

I have tried shooting him fast, slow and every which way in between. I found the way that works for me from trial and error over the past two years. It has been key for us to remain calm and matter of fact while in the process of giving him insulin.

Good Luck!!!!

Pam

[k9diabetes]

I just have a minute but wanted to add a few things...

When you get a chance, check in which Margaret about possibly getting syringes with smaller needles. The 28 gauge Vetsulin syringes are on the large side and even going down to a 29 gauge needle can make a big difference in terms of comfort.

You can angle the syringe different ways, tent the skin different ways, and even inject in a different area since it sounds like she might have some scar tissue or something where you are currently trying to inject.

Here's a diagram of the different areas you can try:

http://www.bd.com/us/diabetes/images/pets/dog_injection_site_selection_graph_wider.jpg

Some people point the syringe down, some lay it almost flat against the body... whatever works is okay.

BD has a slide show on injecting and you might find some tips there:
http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7394

Are you warming up the insulin in the syringe? Cold insulin stings.

And the where you put the bevel can make a difference.

Plus some places a dog just doesn't like. Chris didn't mind his left side but didn't like when I injected on the right side so we just didn't do it there. We used the side of the chest per the diagram above.

Look here if you haven't already: http://www.k9diabetes.com/forum/forumdisplay.php?f=14

I do think finer needles will help.

With her skin issues, she may be very sensitive in places too! Poor girl. You may find that you have to look around for a place where there isn't any bumps or inflammation. Try to identify some of those in advance.

Also, is the new vet working on the skin issue?

Does she have open sores, scar tissue... ?

Natalie

[ajtony]

Thanks Nathalie, Will take all the advice on board and try again in a couple of hours. I will also try and get hold of the finer needles (thanks for the info Margaret). Jessie doesn't have any open sores or scar tissue (yet). I have just picked up on the tip about having the bevel facing up so that may help and I will try and 'dart' the needle as advised. as well. Thanks again, Tony

[ajtony]

Hi Margaret, I have just received 2 boxes of syringes from Pet Drugs online but they are the 1 ml 28G x 1/2" U40 needle. I have just visited their web site to see if I can get 29G needles but cannot find them there. Do I need to order the 0.5 ml U40's or am I missing something on their website. Thanks again, Tony

[jestersmom]

I would try approaching the shot in a whole new way....

Go to the book store and look for Cesar Milan's books. One of them will have great advice on how to give shots, pills, etc in a loving easy way. If you approach shot giving like a battle, so will your dog.

Here are some ideas:
before giving the shot, relax with your dog on the ground, pet the neck area, give a massage, and while doing this, have the needle nearby. RIght now your dog associates the shots with tension, drama, fear, You need to make the association one of comfort, getting a massage, relaxing, etc.

With jester, when we first started, I rubbed his neck, gave him a belly rub, and he was so relaxed and not tense, the shot went right in. You also need to be confident with the needle. Maybe take the used needles and practice on a plum or orange or something to get good at the actual injection. It could be that changing locations won't do much good until your approach changes and your dog is not in panic zone when he sees that needle.

It may help to pretty much simultanesously tent and inject, and by practicing, that will come easier. I use one hand to tent, the other to inject. After the injection, i pat the spot, and say good boy. It takes about three seconds.

Good luck and relax, if you go at the procedure calmly, I think you will be amazed at the ease.

[janspack]

Hi Tony:

I can tell you what we did....my dog is very hyper and had to be muzzled for a while until he got used to the shots.

I'm lucky in that Pip loves to eat. I break up two diabetic cookies and put them on a plate. I make up the needle and when Pip is done eating I pick him up and put him on our counter. I put the plate of broken diabetic cookies in front of him and while he's eating I give him his injection.

As soon as he feels me tent his skin he stops eating to look at me but as soon as I'm done he goes back to eating.

I have tried shooting him fast, slow and every which way in between. I found the way that works for me from trial and error over the past two years. It has been key for us to remain calm and matter of fact while in the process of giving him insulin.

Good Luck!!!!

Pam

I always inject Dazzle when she's eating as well. She's so greedy :) she doesn't even flinch. She's OK to have her injection at other times as well which I've had to do occasionally though so don't know if that will work for Jesse.

As someone else said, the problem gets worse as you get more and more worked up about giving the injection - not an easy situation I know. Could one of you titbit her while the other one gives the shot? What actually does she do? I wonder as she's had a lot of skin problems if her skin is a bit tougher than usual. Maybe you could find a spot somewhere that hasn't had any changes to the skin from her previous problems.

It does get easier - I was really nervous to start with but now it's just something we do twice a day.

[Margaret Boyle]

Hi Margaret, I have just received 2 boxes of syringes from Pet Drugs online but they are the 1 ml 28G x 1/2" U40 needle. I have just visited their web site to see if I can get 29G needles but cannot find them there. Do I need to order the 0.5 ml U40's or am I missing something on their website. Thanks again, Tony

Sorry Tony my mistake, the syringe you are looking for is---

U40 0.5ml Caninsulin syringe
29G x 1/2" needle

Box of 30


I used to use 1ml sorry about that, you will get them no bother.


Margaret

[CarolW]

Tony - quite a few people have told me they've found these pages really helpful.

http://www.coherentdog.org/vek/painlessinj.php

There's also a section on engaging your dog's cooperation.

I'd also have a look at this page:

http://www.coherentdog.org/vek/groomintable.php

Let us know how things go!

Do try to get those 29-gauge needles; it really does make a difference.

If worst comes to worst, you can use even thinner (31-gauge), shorter (5/16-inch) needles, but to use THOSE, you have to make a conversion! They are the WRONG SYRINGES for Vetsulin/Caninsulin, so you cannot use the markings on the barrel in the way the numbers indicate. You have to multiply by 2.5 to get the correct Vetsulin dose.

It is SO dangerous to get the wrong dose that I don't recommend doing that without your vet's approval and double-and-triple-checking that you're doing it right.

But I have some friends who do just that - use "the wrong" syringes, make the conversion, and so, can use the very thn, very short needles.

But I think you'll be okay with the RIGHT syringes, if you can get the 29-gauge ones, and follow the tips forum members are giving you.

Mon, 21 Dec 2009 11:32:19 (PST)

[jestersmom]

My concern is with the approach to giving the injection. I look at dealing with my dog as if I was dealing with a toddler. Get as much prepared ahead of time as possible. Needle ready, check. Treats ready, check. Calmness, check. Dog relaxed, bladder empty, check.

I understand there may be skin issues, etc. So practicing on fruit with water so that the motion of injecting is easy. I can do it with one hand now, while creating tent with the other.

Its a good idea maybe look at other needles etc., but at this point, it seems the whole injection routine is stressful for all, and while a new needle may help, if the same method is used and the doggy is scared, nervous etc., the same issues may keep recurring.

I am always looking at this from the dogs perspective, and how they might feel, and trying to find ways to create the least amount of drama and trauma.

If the injection will be problematic due to skin issues, I would try to find a way to make the injection as comforting, routine and calm as possible for everyone. Also, the person giving the injection needs to be totally confident in piercing the skin and just quickly push right in, with no trepidation. Once the right needle is found, practice so you can just give the shot as quickly as possible. Speed and calm are paramount to getting the job done. THe petting etc, doesn't have to be a long drawn out ritual, just something to create serenity for all.

Good luck, and I know its tough. I once got stuck somewhere and had to give my daughter instructions over the phone for the injections. I told her to just be calm and stick the needle in and not to prolong the injection part, but after to give jester a big hug, belly rub and a good boy.

[ajtony]

Hi guys, Just got Jessie back from the vets. To say I am disgusted would be an understatement. It was a different vet. All he could say was if it was his dog he would let her go because of her skin problems. He didn't even bother mentioning any possible Cushing Disease but I am happy with that for now as the diabetes can come first. So we have stopped the vetoryl and I will try and sort a Vet Hospital appointment asap. The vet couldn't even look me in the eye. I thought he was the shop assistant. He's there if I need a prescription but I would sooner trust this forum than him. He said I may want to increase the caninsulin to 7 or 8 twice a day and when I asked for a printout of the 'curve' he said I would have to come in for it tomorrow. Anyway, I'm off to work (on nights). Just got to try Jessie's shot before I go, Cheers, Tony

[k9diabetes]

Dang, Tony! That's really sad... I have worked with a few people with similarly limited veterinary choices and it's just not fair.

I have come, since Chris' diagnosis with diabetes and severe heart disease, to appreciate where I live because there are probably 100 different vets within an hour's drive and often more than one doctor specializing in things like cardiology and dermatology. I treasure having a choice.

One advantage here in the U.S. is that the older insulins like NPH can be gotten without a prescription so we don't have to be held hostage in order to get a life-saving substance.

If you can find a very sympathetic and caring hospital specialist, that person might be willing to then work with you, after examining Jessie, via email and telephone as much as possible.

I have seen specialists do this in the U.S. - Kay's Bo was a mini Schnauzer with extremely severe diarrhea. She took Bo to the specialist for a thorough exam and then worked with her by telephone after that.

I used to email Chris' cardiologist with questions and even sent her videos of Chris if I wanted her to take a look at something like his breathing. It saved Chris the stress of traveling for things we could handle another way.

I'm really glad you're stopping the Vetoryl as from all I've seen here and at the Cushings forum I think Cushing's is not very likely.

Could you tell us some more about her skin condition (and maybe copy it to the Cushings forum too)?

I have some experience with skin conditions with Chris and have seen a few other dogs along the way. We were able to have a teaching hospital dermatologist who has a worldwide reputation look at Chris' case and make some recommendations. It is possible that he would do that for Jessie.

You never know - someone here may have had a dog with the same problem and can offer some advice. Pictures would be good if you can.

Hang in there... I know it doesn't seem like it but this is progress if it's a bit skewed from what you expected. You've got your insulin prescription, you've got a plan to stop the Vetoryl, and hopefully you will be able to see a more serious hospital about the skin. You've accomplished a LOT in a week's time.

I'm anxious to see the curve numbers too.

Natalie

[k9diabetes]

Let's talk about how much to increase the insulin.

A 2 unit increase generally is not advisable in a dog who is only on 5 units now. If you can get the vet to give you the curve, it would be easier to figure out an increase. I could see circumstances where a 2 unit increase MIGHT be warranted, like if her blood sugar is all in the 600s! Yikes, I hope that's not the case! More likely the increase in the insulin dose should be small - 1/2 to 1 unit. You can eyeball a half unit on the syringe.

Stopping the vetoryl is also likely to influence Jessie's blood sugar. There is a direct correlation between cortisol and other hormone levels and blood sugar so her insulin needs definitely could change when that medication is eliminated.

I think you may be urine testing... I'll have to look. Even that would give us some indication if it was done often for a day.

My heart hurts for all you and Jessie have been through. We have had more than one rural vet who handles mostly livestock just suggest euthanasia in response to a dog being diagnosed with diabetes. It's scary what can happen in the wrong hands.

We can get this sorted out though Tony so don't despair.

Natalie

[BestBuddy]

Hi Tony,

Just wondering about the skin issues. Can you describe what is happening. Pictures would be great if you can.

Jenny

[ajtony]

Thanks to everyone. As soon as get the curve results from the vet we will post it here. In the meantime, unless you tell us different, we will give Jessie her 5 units in the morning and then wait for the curve results. We gave her the last vetoryl on monday morning. We have been testing the urine for glucose but not for ketones (I have only just found out about this and am still tyring to get my head around it). The instruction leaflet was missing from the diastix box so we don't really know what we are doing. All I know is that initially, 3 weeks ago, after the 30 seconds, the colour was dark brown (the furthest shade of colour to the left). It is now on the third shade up which is browny/green and we thought that was a good sign. I will try and get some photos and post them tomorrow. She is very sore around her rear end/vulva and it is black/swollen and occasionally bleeding. She is scratching a lot tonight and very unsettled although she can still jump and off the settee. We don't know what to do for the best with her. She's so much part of the family and I don't want her to suffer. I'd prefer to ease her painful skin problems so that she has a relatively pain free time with us - even if she only has a short time left. My wife Pat has put some calomine lotion on her sore bits tonight, and we have a mild skin shampoo that we use. The only thing that seemed to work on her skin problems was something called 'Atopica' (quite pricey) which we used a couple of months ago, BUT it states in the information sheet not to use on diabetic dogs. Also don't know whether to ask the vet to refer Jessie to the Vet University Hospital in Glasgow, now, or wait until the new year. So many things to think about. And I know there are dogs worse off than Jessie so we must try and remain positive. cheers, Tony

[acushdogsmom]

Hi Tony,

Just wanted to let you know that I just wrote a long reply post to you over at the Cushing's message board.

http://www.k9cushings.com/forum/showthread.php?t=1537&page=2

Also, in addition to the Vet University teaching Hospital in Glasgow (a great choice), Glynda may have found another option for an Internal Medicine Specialist for you, who may be closer to where you are, depending on where you live exactly.

http://www.medicinereferrals.co.uk/

[robertpri]

Tony - quite a few people have told me they've found these pages really helpful.

http://www.coherentdog.org/vek/painlessinj.php



Wow, Carol, your pages are really great. I follow a lot of threads here, just to learn more, and clicked to your injection pages. I had completely forgotten about injecting with the bevel side up. I knew that at one time, but it must have slipped back into my memory abyss.

I had just opened a pack of 10 tonight and used one on Mik. After seeing your site, I pulled the red cap off the remaining 9 needles and there is no pattern from one to the next. The bevel can be anywhere. I will mark barrel with black felt pen from now on.

[Actually, with good light, I went ahead and marked all 9 in advance]

I prep Mik's injection then put it carefully in a nearby dish. It's 3-4 IU Vetsulin and sits there at room temps for 20-40 minutes, while I prep meals and depending on Mik's mood to eat.

I figured that was enough "warm-up" and have never tried the arm pit. Might try that tomorrow.

thanks for great information!

bob

[Margaret Boyle]

Thanks to everyone. As soon as get the curve results from the vet we will post it here. In the meantime, unless you tell us different, we will give Jessie her 5 units in the morning and then wait for the curve results. We gave her the last vetoryl on monday morning. We have been testing the urine for glucose but not for ketones (I have only just found out about this and am still tyring to get my head around it). The instruction leaflet was missing from the diastix box so we don't really know what we are doing. All I know is that initially, 3 weeks ago, after the 30 seconds, the colour was dark brown (the furthest shade of colour to the left). It is now on the third shade up which is browny/green and we thought that was a good sign. I will try and get some photos and post them tomorrow. She is very sore around her rear end/vulva and it is black/swollen and occasionally bleeding. She is scratching a lot tonight and very unsettled although she can still jump and off the settee. We don't know what to do for the best with her. She's so much part of the family and I don't want her to suffer. I'd prefer to ease her painful skin problems so that she has a relatively pain free time with us - even if she only has a short time left. My wife Pat has put some calomine lotion on her sore bits tonight, and we have a mild skin shampoo that we use. The only thing that seemed to work on her skin problems was something called 'Atopica' (quite pricey) which we used a couple of months ago, BUT it states in the information sheet not to use on diabetic dogs. Also don't know whether to ask the vet to refer Jessie to the Vet University Hospital in Glasgow, now, or wait until the new year. So many things to think about. And I know there are dogs worse off than Jessie so we must try and remain positive. cheers, Tony


Hi Tony,

Fantastic I told you there would be lots of people who would help with the skin issues and offer you some advice.:)

I am so glad I actually worried all night about the vets attitude towards Jessie.:(

You will make up your mind about internal specialists once you have done some probing;)

Keep up the good work.:)

Hugs

[CarolW]

Wow, Carol, your pages are really great. I follow a lot of threads here, just to learn more, and clicked to your injection pages. I had completely forgotten about injecting with the bevel side up. I knew that at one time, but it must have slipped back into my memory abyss.

I had just opened a pack of 10 tonight and used one on Mik. After seeing your site, I pulled the red cap off the remaining 9 needles and there is no pattern from one to the next. The bevel can be anywhere. I will mark barrel with black felt pen from now on.

[Actually, with good light, I went ahead and marked all 9 in advance]

I prep Mik's injection then put it carefully in a nearby dish. It's 3-4 IU Vetsulin and sits there at room temps for 20-40 minutes, while I prep meals and depending on Mik's mood to eat.

I figured that was enough "warm-up" and have never tried the arm pit. Might try that tomorrow.

thanks for great information!

bob

Noting that this is Tony and Jessie's thread, and Tony has ONE HECK OF A LOT OF STUFF on his mind right now, what with a possible false positive on Cushings disease, along with diabetes that hasn't yet been brought under control. Tony - I just dropped in quickly on the Cushings forum, and am delighted you seem to be getting excellent assistance there, including in finding a good vet in Glasgow.

Bob - I'm so glad you found the painless-injection pages helpful - lots of people do, or so they tell me. I write in such excruciating detail because I need that for MYSELF! So I figure, maybe some others can use it too.

It is SO EASY to forget one of those steps.

With Jessie, with skin problems, it might be difficult to "tent the skin" - that is, pull up a bit of skin to inject into. In that situation, I'd ask others here what they do in such situations. MAYBE it would be possible to inject without pulling skin up, but instead, if it were me, I would probably try to insert the needle almost parallel to the skin surface, so the needle doesn't go very deep, but slides under the skin with the needle-tip still fairly close to the surface.

The target area for injecting is, typically, the "fat layer just under the skin." There may not be much fat in some areas!

The other thing I'd consider is, for ANYONE - to remember why you are doing this - to feel, at the time you are preparing the syringe, the deep, deep pleasure in knowing that with EVERY injection, you are saving your dog's life. To enjoy that. And - to REMEMBER TO BREATHE!

Dogs really notice when we hold our breaths. Singing and crooning to your dog is a good way to make sure you are breathing when you do this job.

I hope others can help with the idea of how to inject if you're not going to "tent the skin."

And, Bob, thank you so much for letting me know those pages were helpful to you, too.

Oops - Bob - I forgot one thing. I prefer not to let a filled syringe sit for 20 to 40 minutes, as the insulin may settle a bit if you do that. That's why I fill the syringe only very shortly before injecting, and use the armpit-warming technique, instead of letting the insulin come to room temperature. Also, when I inject, I like to be able to feel, through the syringe-barrel, that the temperature feels "distinctly warm" to the fingers. That will be much more nearly at the dog's body-temperature than room-temperature is! Tony - that might make a useful difference to Jessie, as well.

Tony - I'm watching you and Jessie, and wishing you everything good.

Wed, 23 Dec 2009 08:15:33 (PST)

[Margaret Boyle]

Noting that this is Tony and Jessie's thread, and Tony has ONE HECK OF A LOT OF STUFF on his mind right now, what with a possible false positive on Cushings disease, along with diabetes that hasn't yet been brought under control. Tony - I just dropped in quickly on the Cushings forum, and am delighted you seem to be getting excellent assistance there, including in finding a good vet in Glasgow.

Bob - I'm so glad you found the painless-injection pages helpful - lots of people do, or so they tell me. I write in such excruciating detail because I need that for MYSELF! So I figure, maybe some others can use it too.

It is SO EASY to forget one of those steps.

With Jessie, with skin problems, it might be difficult to "tent the skin" - that is, pull up a bit of skin to inject into. In that situation, I'd ask others here what they do in such situations. MAYBE it would be possible to inject without pulling skin up, but instead, if it were me, I would probably try to insert the needle almost parallel to the skin surface, so the needle doesn't go very deep, but slides under the skin with the needle-tip still fairly close to the surface.

The target area for injecting is, typically, the "fat layer just under the skin." There may not be much fat in some areas!

The other thing I'd consider is, for ANYONE - to remember why you are doing this - to feel, at the time you are preparing the syringe, the deep, deep pleasure in knowing that with EVERY injection, you are saving your dog's life. To enjoy that. And - to REMEMBER TO BREATHE!

Dogs really notice when we hold our breaths. Singing and crooning to your dog is a good way to make sure you are breathing when you do this job.

I hope others can help with the idea of how to inject if you're not going to "tent the skin."

And, Bob, thank you so much for letting me know those pages were helpful to you, too.

Oops - Bob - I forgot one thing. I prefer not to let a filled syringe sit for 20 to 40 minutes, as the insulin may settle a bit if you do that. That's why I fill the syringe only very shortly before injecting, and use the armpit-warming technique, instead of letting the insulin come to room temperature. Also, when I inject, I like to be able to feel, through the syringe-barrel, that the temperature feels "distinctly warm" to the fingers. That will be much more nearly at the dog's body-temperature than room-temperature is! Tony - that might make a useful difference to Jessie, as well.

Tony - I'm watching you and Jessie, and wishing you everything good.

Wed, 23 Dec 2009 08:15:33 (PST)


Carol sorry for butting in here but quite a few have came in with tips about not tenting the skin and I had said to Tony about placing the needle parallel to the skin, Lucy does not like tenting and this is what I do.

You must have missed the post where we were talking about this.

Hugs Margaret

[CarolW]

Carol sorry for butting in here but quite a few have came in with tips about not tenting the skin and I had said to Tony about placing the needle parallel to the skin, Lucy does not like tenting and this is what I do.

You must have missed the post where we were talking about this.

Hugs Margaret

I did miss it, Margaret - thanks so very, very much for pointing it out to me! So that placing the needle parallel to the skin does seem to be the way to go! I'm really glad to know that.

THANKS!

Wed, 23 Dec 2009 09:47:02 (PST)

[robertpri]

Oddly enough, Mik does not mind the tenting. [he does not like much of anything these days, but the tenting does not bother him]

But I "pinch" a tent in one spot, let it go, pinch another one, let it go, and he kind of gets used to it. Then when the skin\flesh looks just right and Mik is calm, I use the syringe which has been at the ready in my right hand.

I then pinch another tent, and another one, so a total of maybe 10 times. Somewhere in the middle, he gets the shot. Mostly, he is unaware of when he got the shot. Over the year, he has slightly moaned about three times. I must have been off a bit.

I had not thought of the insulin 'settling' in 20-40 minutes while it warms up. I will try the armpit method tonight.

[CarolW]

Bob - I LOVE your multiple-tents idea! Fabulous! Wouldn't probably work so well with Jessie, with her skin problems, but for a dog who is comfortable with tenting, it's IDEAL!

Some people warm the contents of the syringe in their mouths - I don't like to get saliva on the syringe barrel, so I don't do that; haha! I warm in my armpit, from 15 to 30 seconds.

Wed, 23 Dec 2009 10:14:08 (PST)

[robertpri]

Bob - I LOVE your multiple-tents idea! Fabulous! Wouldn't probably work so well with Jessie, with her skin problems, but for a dog who is comfortable with tenting, it's IDEAL!

Some people warm the contents of the syringe in their mouths - I don't like to get saliva on the syringe barrel, so I don't do that; haha! I warm in my armpit, from 15 to 30 seconds.

Wed, 23 Dec 2009 10:14:08 (PST)

I read [here?] about the mouth idea. Somebody said they put the barrel 'sideways', or sort of 'across' their mouth, just between the lips. [in front of their teeth]

I tried this on an empty syringe for practise, and it did not seem all that awkward. How effective to warm, I don't know.

I like the idea of marking syringes. I tried black, but it was too confusing with the black lines on the barrel, so I use Red, and mark them in advance.

[ajtony]

Hi Margaret/Guys, 24 hours is such a long time with a sick doggy isn't it. After the despair of Tuesday, today we all feel a lot better. We revisited the vet Practice and saw the vet who first saw Jessie a week ago and he was just fine. I think we must have met his Dr Jekyll partner yesterday. Anyway, the Mr Hyde (or have i got that the wrong way around?) vet said he would be happy to refer us to an IMS, even Glasgow University Vet Hospital but he suggested we wait until the New Year as he wants to get Jessie regulated first. The Cushings can wait until then. We were happy with that. The new 29G needles arrived and it was much easier giving Jessie her injection tonight! And a book arrived from Annette with tips about blind dogs (Thanks Annette) so we are readin up on that. I will post the curve results next. Thanks again, Tony. PS I have posted some photos of Jessie and her skin.ear infection.

[ajtony]

Hi Jenny, just posted some photos of Jessie's sore vulva area. The rest of her coat isn't that bad at present - its mainly her ear infections and vulva. cheers, Tony

[ajtony]

Hi Carol, excellent tips on your site thanks. We used a 29G needle tonight and it was much easier. Jessie still flinches/struggles when we make any sort of tent in the skin but I think we bored her to tears in the end with our rendition of, 'How much is that doggy in the window'. Ha, Ha. Thanks again, Tony

[ajtony]

Hi Nathalie, Right, here are the figures from the curve done yesterday. Jessie was given her shot about 5 minutes before they did the first test and she was quite stressed due to the vet giving the shot very roughly. She was fed about 40 minutes before that.

0900 hrs 24.6 (x 18 for US (is that right? = 442.8)

11.20 hrs 17.6 (316.8)

1220 hrs 18.4 (331.2)

1530 hrs 16.2 (291.6)

1700 hrs 17.6 (316.8)

As far as we know she wasn't fed anything during this time. the vet said go onto 7 units of caninsulin twice a day (she has been on 5 units ) but tonight we just went up to 6 units. What do you think? She is booked to go back in for anothet curve in 10 days.

We are presntly feeding her half her food at about 8am and then the rest 11/12 hours later. She gets a dental chew in the evening and home made treats/green beans when getting her shot.
Cheers, Tony

[robertpri]

Others are this forum are the experts, but in my opinion, you are increasing the insulin exactly right by going from 5 to 6, then 6 to 7.

A jump directly from 5 units to 7 is a 40% increase. Unless the BG readings are really high, I think that's too much an increase at one time.

I increased Mik +.5 units a day for 1-2 days, then another +.5, etc.

My opinion only....

[k9diabetes]

The curve looks pretty good Tony, especially given all the stress poor Jessie has been under. You will have to tell Dr. Jekyl that Mr. Hyde is no longer allowed to have any contact with her though!

I would never ever do a 2 unit increase for a dog getting 5 units, even her blood sugar had been a LOT higher than it was. So I'm glad you went up just 1 unit. If you see her urine tests go negative, I would cut back to 5.5 units and leave it there for a while. It can take a few days for things to settle in.

The particularly nice thing about the curve is how flat her blood sugar levels stayed. If it stays that way when her BG gets into lower numbers, she will regulate beautifully.

Very nice!

Hope you have a lovely holiday. Should be a lot easier to do now...

Natalie

[k9diabetes]

I've just looked at Jessie's photos... has this crud she has ever been diagnosed as anything?

Has she ever been put on antibiotics or fungal or mite treatment?

Whatever else she might have, I would think antibiotics would be needed as anytime the skin is moist and inflamed bacteria are likely to grow as well.

What does the new vet say about this?

Natalie

[k9diabetes]

So Jessie did well on cyclosporine (Atopica)... there is a fairly extensive site on the maker's page here:

http://www.us.atopica.com/vIndexVet.shtml

http://www.atopica.com/about_ad/en/index.shtml

I looked at the product label

http://www.us.atopica.com/pdf/04-08-product_label.pdf

and it did not include diabetes as a contraindication, only dogs with is a history of neoplasia.

I know of at least one diabetic dog some years ago who received cyclosporine for her auto-immune disease.

This is an immune-system suppressing drug, which probably is just what Jessie needs. They might want to clear up any infectious agents before putting her back on it but it looks like she perhaps could go back on Atopica.

I also know of a Westie whose allergies were so bad that he had to have steroids his entire life. Which made managing his diabetes a lot more difficult - he needed a high dose of insulin - but it was that or he would bleed to death from stomach ulcers. So he got steroids and insulin and they made it work.

[k9diabetes]

I found another page on Atopica that references diabetes and says it is not recommended... same manufacturer!


Cyclosporine may affect the circulating levels of insulin. In dogs with signs suggestive of diabetes mellitus, glucose levels must be monitored. The use of ATOPICA is not recommended in diabetic dogs.


http://www.ah.novartis.com/products/en/atopica_dog.shtml

They should make up their mind! :)

Anyway, I'd take it up with the vet specialist. Sometimes you have to do something like this even if it's not ideal for diabetics - depends on what the consequences of doing it are, which I haven't seen in detail anywhere yet.

Natalie

[BestBuddy]

Buddy had cyclosporine ointment put into his eyes for ongoing ulcers and we were told to keep a check on his BG's but to be honest we didn't notice anything unusual.

Jenny

[ajtony]

Hi Nathalie, Over the years Jessie has been on various abx, steroids, creams, and other stuff that I can't remember. She hasnt been this bad before though. There never was a diagnosis, it is far too easy for the vet to say it is just a 'westie problem'. That was the reason we left the first vet. He did check for mites a few months ago and gave us some strong 'frontline' like stuff to put on her and that cleared up the scabs on the rest of her body. The new vet has given us abx and says he will monitor it. Also, she has not been able to walk on her right hind paw for a few days and it sore, so much so that we can't really get a good look at it.

I am encouraged re your words about the curve Nathalie. Thanks everyone, all the best, Tony

[jestersmom]

What as the vet said about food allergies. We had a dog who was going nuts scratching and we put her on a pure meat diet, with no fillers- no wheat, no oats, just what I cooked at home.

Her itching stopped. Not the ideal diet for a diabetic dog, but better than skin irritation.

I knew it was the wheat or oat or whatever fillers, cause after eating just meat for a week, and then trying some dry food, she started going nuts again scratching.

This is what our vet recommended. Go for one kind of protein- beef for a week. If no irritation, then add another protein or rice. Try that for a week. Then add a very PURE kind of dry food- one with JUST one kind of grain....if after a week, add another. We did this and as soon as we added a grain of any kind, the itchy scratchy show started again. Also if her paw is raw and sore, she may be locking or biting it due to itching, and that is one of the first places dogs feel a food allergy.

One other thing to consider, and it may not be pertinent to your house, but often carpets have chemicals in them that cause allergies. We have no carpets in our house because if I sit on a carpet for anything of time, my eyes start to water, and my hands get itchy. It may be the carpet or what you are cleaning your carpet or floors with. Its worth looking at everything to see what is cause the reaction, which probably feels like hives.

I know a pure meat diet (well rice was fine) is not ideal, but we supplement with gravy vitamans.

Good luck

[ajtony]

Hi Guys, UPDATE ON JESSIE!
Jessie is doing really well at present and apart from the blindness she seems to be better than she has been for months - we are really pleased! She's coping much better with her blindness, getting around the house and garden better and the ABX have had a positive affect on her skin complaint (although i't not totally cleared up). She is still showing no symptoms of the originally diagnosed Cushings!

She has got to the stage now where she grumbles a little bit but then allows me to give the injection and it is not such a big issue anymore. After having her on the 6 units if Caninsulin for 11 days her b/g level although not regulated seems to be better. We are using Diastix strips and there is not much of a change in the 3 or 4 urine tests we do a day - although it does show high (28 mmol/L or very occasionally 56 mmol/L) in the evening an hour or two after her meal. During the day it is usually 14 mmol/L or very occasionally 5.5 mmol/L. The vet wont do another curve for another 2 weeks at least so I was wondering whether to continue on 6 units of caninsulin or increase to 2 x 6.5 units (she weighs 8 kg). The vet originally said increase to 2 x 7 units but we wanted to take it slowly. Once again, thanks to all of you. Don't know how we would have gotten through this last 3/4 weeks without your support. best wishes, Tony

[eileen]

Another suggestion as a replacement protein for both beef and chicken is white fish.
I home cook for Mildred, her diet consists of Pollock (white fish), sweet potatoes, cauliflower, broccoli and pure pumpkin. Of course supplementing with various vitamins and minerals.

Tony, something to keep in mind when bg indications are seen from one extreme to another within a day is the possibility of rebounding.
I'd be a bit concerned with increasing the insulin without another actual blood curve as altho urine testing does show some indication of where their glucose levels are it is not really definitive enough to rely on in itself.

Having not read all of your posts leading up to the present so not sure if this has been touched on.....
Is learning to blood test yourself at home not an option? The information that it provides on a daily basis is priceless.

Eileen/Mildred

[ajtony]

Hi Eileen, Blood testing at home is something we want to get into but it has been particularly stressful injecting the insulin for a few weeks and others thought it best to let Jessie get used to them before we start taking blood as well. I wont increase the caninsulin until I get a few more replies but the vet has already told us to go straight from 5 units to 7 (we actually went from 5 to 6 to be on the safe side). Thanks for the advice, Tony

[eileen]

O.K., I understand,we all have to do what we are comfortable with.

I started blood testing Mildred the very same day she was diagnosed as I see it as important right along with the insulin itself.
I have no doubt that with all my girl has been thru over the years she would not have made it had I not learned to test and understand the readings I see.

I'm glad to read that you are increasing in small increments as sometimes with small dosing such as this even a 1/4u can make all of the difference...you really don't want to increase too much all at once as it is easy to create problems by increasing by too large of a dose. Much easier to 'go forward' with a dose than to overdose, have rebound or hypo and have to back off. Best to creep UP TO the acceptable dose.

My concerns with your Jessie at this point would be the high indications you are seeing along side the lower ones. I would really like to see blood test results before any more of an increase. It is usually standard safe practice to run a curve, make any adjustment in dose, give that time to settle in, then run another blood curve before deciding upon any further changes.

It is my belief that urine results are just not that safe to rely on ESPECIALLY as the dog (or cat) is in it's early stages of 'regulation'. Once time passes and one learns how their dog reacts to different doses as well as outward signs such as excessive drinking and the activity level it is better used as a guide...just not to try and find that first stage of regulation.

It all takes time...and a whole lot of patience.
Eileen/Mildred

[CraigM]

Tony,
Annie weighs about the same as Jessie (7.25Kg) and at times (!) seems regulated with 7.25iu of Vetsulin / Caninsulin. I've noticed Annie is fairly critical in her injections: Recently 7.0iu isn't enough, while 7.5iu requires a small snack at around +9 hours to keep her from going low. Of course each dog is different and different conditions apply, but I'd keep the change small.

Craig & Annie

[Soaphie & Sydney's Mom]

Wow Tony!

I was just reading back through to the beginning of your diabetes journey with Jessie.....it's only been about a month! Kudos to you for already making so much progress.

Tami & Soaphie

[k9diabetes]

That's all really wonderful news Tony! What a great Christmas / New Year's gift for you all. :) I knew you would get things sorted out.


After having her on the 6 units if Caninsulin for 11 days her b/g level although not regulated seems to be better. We are using Diastix strips and there is not much of a change in the 3 or 4 urine tests we do a day - although it does show high (28 mmol/L or very occasionally 56 mmol/L) in the evening an hour or two after her meal. During the day it is usually 14 mmol/L or very occasionally 5.5 mmol/L. The vet wont do another curve for another 2 weeks at least so I was wondering whether to continue on 6 units of caninsulin or increase to 2 x 6.5 units (she weighs 8 kg).

Curve on 5 units:
0900 hrs 24.6 (442.8)
11.20 hrs 17.6 (316.8)
1220 hrs 18.4 (331.2)
1530 hrs 16.2 (291.6)
1700 hrs 17.6 (316.8)

It looks to me like the low and high blood sugar results on the urine tests match up pretty well with her curve. The curve done was pretty flat in terms of how much difference there was between the highest and lowest blood sugar. It's not unusual, though, for that difference to get larger when you get closer to the right dose of insulin, which could be what you're seeing on the urine tests now.

How long is she going to be on the antibiotic?

Is there a set time of day you test the urine? If so, when do you that relative to her food and insulin?

Antibiotics can affect the blood sugar... if she's nearly finished with it, I think I'd suggest waiting until she's done with it to see how the urine tests look then.

But if she's going to be on it long-term, you wouldn't want to wait for that.

Natalie

[ajtony]

Hi Nathalie & all, Jessie will be finishing her abx in a couple of days. The figures I posted re the diastix are repeated below with times of testing.

We are using Diastix strips and there is not much of a change in the 3 or 4 urine tests we do a day - although it does show high (28 mmol/L or very occasionally 56 mmol/L) in the evening an hour or two after her meal. During the day it is usually 14 mmol/L or very occasionally 5.5 mmol/L. The daytime tests are done 2/3 hours after her morning meal and is the 2nd/3rd pee of the day and then we do another about 3 hrs later. So that would be about 11.00 hrs, 16.00 hrs and 20.30 hrs. She is fed at 0800 hrs and 19.00 hrs ish which is about 20 minutes before her insulin shots.

Must get into home blood testing. all the best, Tony

[Margaret Boyle]

Hi Nathalie & all, Jessie will be finishing her abx in a couple of days. The figures I posted re the diastix are repeated below with times of testing.

We are using Diastix strips and there is not much of a change in the 3 or 4 urine tests we do a day - although it does show high (28 mmol/L or very occasionally 56 mmol/L) in the evening an hour or two after her meal. During the day it is usually 14 mmol/L or very occasionally 5.5 mmol/L. The daytime tests are done 2/3 hours after her morning meal and is the 2nd/3rd pee of the day and then we do another about 3 hrs later. So that would be about 11.00 hrs, 16.00 hrs and 20.30 hrs. She is fed at 0800 hrs and 19.00 hrs ish which is about 20 minutes before her insulin shots.

Must get into home blood testing. all the best, Tony


Hi Tony,

I am glad Jessie is doing a lot better:)

I told you it would get easier as you go along, you sound more confident now.

We all know what it was like when we all first started:rolleyes:

Well done.


All the very best to you both.

Hugs

[k9diabetes]

So just to make sure I understand,

08:00am food and insulin
11:00am urine test
04:00pm urine test
07:00pm food and insulin
08:30pm urine test

Is that right?

And then you're getting the higher urine test readings with 6 units at the 8:30pm test while the ones earlier in the day are quite a bit better.

Curve on 5 units:
0900 hrs 24.6 (442.8)
11.20 hrs 17.6 (316.8)
1220 hrs 18.4 (331.2)
1530 hrs 16.2 (291.6)
1700 hrs 17.6 (316.8)

My feeling is that there may now be a bigger difference between the highest and the lowest blood sugar. I've seen this happen - the curve on not enough insulin stays fairly flat but deepens as you bring the insulin dose up. Which does open up the potential for lows and rebound.

Given that you're almost through with the antibiotic, I recommend making no increase in the insulin dose. Stay at 6 units.

When she's been off of the antibiotic for a couple of days, do some urine tests and see if the pattern has changed.

Home testing blood sugar gives a lot more information but you also don't want to sacrifice the cooperation you have gained with her injections, which are much more important. So I'm in no rush for you to start home testing blood glucose.

Natalie

[ajtony]

Thanks Nathalie, 6 units it is then. Yes, the times for the food, insulin and urine testings you wrote down are about right. Is there anything we can do regarding the higher reading at about 8.30pm? What does it actually mean in laymans terms? Sorry if this is a silly question but there is so much stuff in my head at the moment I thing i am getting it all mixed up. cheers, Tony

[k9diabetes]

There's no way to know if the higher urine test in the evening is an accumulation of steadily high blood sugar or whether the BG is dropping and then rising sharply from rebound or just because the insulin isn't lasting long enough... at least not without a bunch of urine tests.

Just speaking very roughly, I could see blood sugar of 14 (250ish) at noon that rises to 17 (306) by dinner time could give you the same urine results as blood sugar that drops to 9 (162) and rises to 22 (396) in the last few hours before dinner.

It's not a very sensitive test. But it's better than no testing at all.

Would Jessie pretty much wee on command for you?

If so, you could pick a day and test her every hour or hour and a half if he can provide that often and you would get a somewhat more detailed picture.

A blood glucose curve is what you need to properly sort it out.

It doesn't necessarily take a lot of high blood sugar to generate quite a bit of glucose in the urine and the longer the bladder gathers glucose from the blood, the higher the test will be.

Mainly I want to see if anything changes when she goes off of the antibiotic.

That the BG is dropping in the daytime is good for Jessie and once you can get a curve done you will know a lot more.

Natalie

[ajtony]

Thanks Nathalie, I've just given her the last abx capsule so tomorrow we will urine test throughout the day (thats if the testing strips come through the mail today). She is due to go for a curve in a week or so. best wishes, Tony

[k9diabetes]

A week sounds good. I would just feel much better making a dosing decision based on a curve.

Natalie

[ajtony]

Hi Nathalie, We tested Jessie's urine 5 times yesterday (every time she had a pee). I know these tests are not very accurate but this is what the diastix showed anyway.

0800 28 mmol/L
0815 fed
0830 6 units caninsulin
1100 28 mmol/L
1330 dental chew (I was told it was Ok to give her this)
1500 14 mmol/L
1900 fed
1930 6 units caninsulin
2000 55 mmol/L
2230 28 mmol/L
No ketone showed.

and this morning at 0800 she was at 55 mmol/L first thing

The injections are now a piece of cake. She has settled down with them and seems to trust us with them. It literally takes us a minute and then she gets a few small pieces of chicken (no skin). All we need to progress onto now is giving her the shot without two of us having to be present (one to keep her still and calm) but I'm sure that will come.

She's still very itchy and scratches a lot - the abx seemed to work on her skin problems for a few days but then not.

Thanks again, Tony & Jessie

[k9diabetes]

Our dog had an autoimmune skin problem for about a year and the antibiotics helped in that they cleared up the secondary bacterial infections but they didn't do anything for the underlying disorder. Jessie probably has the same problem and it's so annoying because unless you can tackle the underlying problem, the bacterial infection comes back almost as soon as they finish the antibiotics! I hated that.

If you wind up seeing the specialist, perhaps you can talk to him/her about using cyclosporine. If not an oral one, maybe you could use it topically on the skin that's irritated. That's what we did with our dog. He had ulcerations on his face and we just applied Tacrolimus ointment to them.

Natalie

[ajtony]

Jessie has just been in for a curve and here are her results.

8am fed
0915 21.0 (378)
1130 14.9 (268)
1540 17.2 (309)
1700 20.9 (376)

We have been giving her 6.5 units of caninsulin. The vet recommends we up that to 9 units twice a day. What we have done is increased it to 7.5 unts twice a day, and then in a few days we will increase again by a half or 1 unit. We are not blood testing at home so use diastix to give us an indication of levels. The vet said the readings on diastix could be up and down for a couple of days and as long as Jessie didn't have any other symptoms, eg, drinking/peeing lots more, lethargy, signs of 'drunkeness' etc he wouldn't worry. Last night 3 hrs after her meal the diastix reading showed negative and it was the same this morning before her meal. Throughout the day yesterday the reading were just about in the middle of the diastix range on the side of the container. Jessie has no other symptoms and appears just fine. We are in the process of changing her food to Burns High Oats for diabetic dogs, and we are doing this gradually, over a week or so. Any advice would be much appreciated. Tony

[robertpri]

. We are not blood testing at home so use diastix to give us an indication of levels. The vet said the readings on diastix could be up and down for a couple of days and as long as Jessie didn't have any other symptoms, eg, drinking/peeing lots more, lethargy, signs of 'drunkeness' etc he wouldn't worry. Last night 3 hrs after her meal the diastix reading showed negative and it was the same this morning before her meal. Throughout the day yesterday the reading were just about in the middle of the diastix range on the side of the container. Jessie has no other symptoms and appears just fine.

FWIW: My Mik is about the same as your Jessie. After months of slowly increasing his Vetsulin to get him below that Diastix 'mid to high' BG range, he is now testing toward the negative side. I have reduced his dosage a bit, but by mid afternoon, the BG's on the urine test strips are way high again. Like you, I am always seeking advice.
bob

[peggy0]

I wouldn't be considering 9 for sure. A 1 unit increase for Forbin can affect his BGs by 100. If you've increased him to 7.5, I'd be monitoring closely for several days. I dont increase more than 1/2 unit and I wouldn't change the food until I had the dosage where I wanted it to be. HOpe this helps.

[k9diabetes]

Hi Tony,

I just have a moment but will check back in later. Glad you didn't raise the dose as high as suggested.

Natalie

[k9diabetes]

Hi Tony,

I'm finally back again and trying to get caught up.

First thought about the curve is that it's nice and flat, which is wonderful. That allows you to raise the insulin to try to bring all of the blood sugar levels down.

I would never recommend making such a large increase in a dose as small as this one. Adding 2.5 units would be approaching a 40% increase in the insulin dose! Which scares the heck out of me. Even in dogs on a lot more units per injection, a 1 unit increase can make a big difference.

I would give her at least five days on 7.5 units before deciding whether to increase the dose.

And I wouldn't increase the insulin dose until after you finish the food change as that can seriously affect the blood sugar response.

How long will the food transition take?

The high fiber prescription diet used her in the U.S. (WD) can sometimes result in a dog using a lot less insulin than they needed on another food. And any time you change foods it's pretty much a guessing game how it will affect the blood sugar peaks and valleys.

I'm so happy to see that she is responding well and that her blood sugar is dropping. Another unit or two and you should be in a good spot!

Very good news! :)

Natalie

[ajtony]

Nathalie, thanks, we will watch Jessie very closely and if she's OK we will increase to 8 units after 5 days as you say. She will then be in for another curve. We have decided to delay the food change until she is regulated - it seems far less hassle and she wasn't eating all the new food, so I suppose that could affect her b/g levels. cheers, Tony & Jessie

[ajtony]

Hi Guys, Jessie has been in for a curve today and here are the results.

0745 fed
0800 8 units caninsulin
0900 15.4 (277)
1200 8.9 (160)
1500 5.6 (101)
1700 8.6 (155)

We feed her again at 1900 hrs and then give her another 8 unit shot.

The vet is happy with the curve although puzzled at the high reading at 0900 hrs. He has told us to keep her on 8 units and take her back in 1 month for a check up.

Any ideas as to why the morning reading would be high after her feed? Could it be stress related i.e she's been taken to the vet and it's not her favourite place! Or could it be the ABX we give her with her meal (Ampicare 1 x 250mg tablet with her am meal and her pm meal). Anyway, we are very happy and once again would like to thank you all for the friendly advice. Jessie has also put on 0.2 kg so that's good too. Her skin problems continue and the vet says we will send her to a specialist if we want one when her b/g levels are regulated. Thanks again, Tony & Jessie

[k9diabetes]

I just have a second Tony but Holy Cow!!!! That's absolutely beautiful!!! :) I am so happy to see this.

Natalie

[Margaret Boyle]

Hi Guys, Jessie has been in for a curve today and here are the results.

0745 fed
0800 8 units caninsulin
0900 15.4 (277)
1200 8.9 (160)
1500 5.6 (101)
1700 8.6 (155)

We feed her again at 1900 hrs and then give her another 8 unit shot.

The vet is happy with the curve although puzzled at the high reading at 0900 hrs. He has told us to keep her on 8 units and take her back in 1 month for a check up.

Any ideas as to why the morning reading would be high after her feed? Could it be stress related i.e she's been taken to the vet and it's not her favourite place! Or could it be the ABX we give her with her meal (Ampicare 1 x 250mg tablet with her am meal and her pm meal). Anyway, we are very happy and once again would like to thank you all for the friendly advice. Jessie has also put on 0.2 kg so that's good too. Her skin problems continue and the vet says we will send her to a specialist if we want one when her b/g levels are regulated. Thanks again, Tony & Jessie



Tony and Pat,

Fantastic numbers:D:D:D

Marg

[CraigM]

Tony,
About the 0900 reading: I would say that's completely normal. I think Annie's post-meal numbers are up >100, and usually takes about four hours to drop back through the pre-meal number. Those are great numbers!

Most food causes BG to rise, while the insulin may take a hour or longer to start (onset) it's action.

Craig & Annie

[Patty]

I agree with Craig on the post meal spike...She doesn't stay up there very long.

Beautiful!
Patty

[k9diabetes]

I agree that the 277 is a "post-prandial" (post-meal) spiking of glucose, which just means that the food digestion gets started a little faster than the insulin so it gets ahead for a while.

It's a really short-lived spike and not all that high so I wouldn't worry about it at this point with the rest of her blood sugar in such a good range.

If you wanted to try to get rid of it, changes in diet could possibly reduce how high the BG goes or even eliminate it. They are challenging as you just have to try things and see how it goes so are difficult to do without home blood glucose testing.

I'm just absolutely thrilled for Jessie! Wow what a difference a few weeks makes. Congratulations!!

Natalie

[ajtony]

Guys, Praise the Lord! Jessie says, 'Ta (that's thank you ) very much' and so do I. Next on the agenda is to look at the possibility of cataract surgery- it would be so great for her to be able to see again. I think we have dismissed the possibility of Cushings as there are NO symptoms of it at all but we will see what the vet says next month. God bless you and as they say in Scotland, 'Lang may yer lum reek!' Tony & Jessie

[peggy0]

My dog had cataract surgery, sees wonderfully, Margs Lucy had it as well. Everything went well!

[ajtony]

Hi Guys, haven't posted for a while but been reading posts. Jessie has been fine and is getting more confident with her blindness as the days go by. We've been giving her some natural remedies, yoghurt, cider vinegar and cream for her skin problems and it is much better. She went in for a curve today and here are her results.
0745 fed
0800 8 units caninsulin
0900 7.8 (140.4)
11.30 9.7 (174.6)
1300 5.7 (91.26)
1530 2.9 (52.2)
1700 2.5 (45)

We got her home at 1730 and gave her the yoghurt and some chicken pieces. She will be fed at 1900 hrs and get her second shot half an hour later.

The vet says everything is fine and keep things as they are but I am a bit concerned with the 2 low readings in the afternoon. Since her last curve we have changed her diet and she is now on Burns High Oats in the morning and then 11/12 hrs later. At about 1300 hrs we usually give her half a cup of natural yoghurt with a few small piueces of chicken in it but she didnt get that at the vet today.

Any advice? I was thinking we may have to reduce her caninsulin when she changed to the Burns High Oats. We give her 8 units, twice a day after her meal. Shall we just leave it and put it down to the fact that Jessie didnt have her 1300 hrs snack or should we cut the caninsulin dose by half a unit. She really has been fine so I am reluctant to change unless those readings are too low Thanks, Tony & Jessie

[CarolW]

Tony - thanks for posting the numbers. I agree with you; those two afternoon ones are too low. At least Jessie was in the vet's office, so if she'd gone into a hypo the vet could have done something about it.

Too bad the vet didn't give her normal snack! Did you talk that over with the vet? I'd probably talk it over.

Hard to tell what might have happened, if Jessie had had her snack.

I can't help noticing, too, that the people in the U.S. who are changing (by force, really) from Vetsulin (same stuff as Caninsulin) to NPH insulin are mostly reporting excellent success, though it takes a few weeks to make the change.

Guess the situation is different in Scotland; NPH insulin there, for all I know, might cost a mint, and I have no idea how available it is. Here in Canada, we have Caninsulin (with no supply problems), and also, NPH insulin you can buy, without a prescription - at any chemist (pharmacist).

I've heard such good things about Burns High Oats - Marg and Lucy have that! I kinda wish we had that food here in Canada, but I can't complain, because my Kumbi is doing very well on his food.

I haven't a notion whether you and your vet might consider a change of insulin, If not, you would need to keep an eye on those lows. Jessie's higher numbers look absolutely fabulous, though!

I'll look forward to seeing what others have to say.

Tue, 23 Feb 2010 11:14:42 (PST)

[peggy0]

Hi Tony,

Yes those lows are frightening. If you aren't monitoring her at home, I would definately decrease 1/2 a unit, and make sure she gets her treat. Have you considered monitoring? It would give you some peace of mind as to what's going on in the afternoon.

[eyelostit]

Hi Guys, haven't posted for a while but been reading posts. Jessie has been fine and is getting more confident with her blindness as the days go by. We've been giving her some natural remedies, yoghurt, cider vinegar and cream for her skin problems and it is much better. She went in for a curve today and here are her results.
0745 fed
0800 8 units caninsulin
0900 7.8 (140.4)
11.30 9.7 (174.6)
1300 5.7 (91.26) I would give treat at 12:30
1530 2.9 (52.2)
1700 2.5 (45)

We got her home at 1730 and gave her the yoghurt and some chicken pieces. She will be fed at 1900 hrs and get her second shot half an hour later.

The vet says everything is fine and keep things as they are but I am a bit concerned with the 2 low readings in the afternoon. Since her last curve we have changed her diet and she is now on Burns High Oats in the morning and then 11/12 hrs later. At about 1300 hrs we usually give her half a cup of natural yoghurt with a few small piueces of chicken in it but she didnt get that at the vet today.

Any advice? I was thinking we may have to reduce her caninsulin when she changed to the Burns High Oats. We give her 8 units, twice a day after her meal. Shall we just leave it and put it down to the fact that Jessie didnt have her 1300 hrs snack or should we cut the caninsulin dose by half a unit. She really has been fine so I am reluctant to change unless those readings are too low Thanks, Tony & Jessie

I would decrease the insulin a 1/2 unit and check bg at 1:00 and 2:00 and every hour till feeding if you can. I'd like to see that 52 and 45 go away and be a 100-90 at fast.

Jessie may have been stressed at the vet for the curve. You could increase the food a bit to offset the low or give a treat at 12:30 where I posted above on your post.

Nice curve! just need an adjustment either a bit more food or decrease the insulin 1/2 unit see how that goes. Later you can always go up to the 8 units again if bg is running high.

Don't know why the vet wasn't concerned with those low figures.

Dolly & Niki :)

[ajtony]

Peggy, Dolly & Niki, CarolW, Kwali & Kumbi, thanks for the advice. Unfortunately the calibre of vet here in the highlands of Scotland is poor and our present vet just doesn't seem to have the knowledge to treat Jessie. That said, at least he will give us the insulin (we need a prescription for it here), but that's about all. This is our third vet since December and there isn't really anywhere else to go. SO, we will take all the expert advice we can from you guys, and reduce the 8 units to 7.5 units twice daily. Jessie seems to have regulated quite well on the caninsulin and as she has been fine I don't really want to change yet - but am aware it may happen. We want to explore cataract surgery for Jessie but the vet said wait for another 6 weeks because she has only just settled down? Anyway, thanks again. We will keep a close eye on Jessie and explore further home blood testing. Tony & Jessie

Jessie, 8 yr old Westie, Scotland, diabetic since Dec 09, blind, bad skin problems, 8 units of caninsulin twice daily (soon to be 7.5), Burns High Oats, natural yoghurt, apple cider vinegar, Dermacton cream, Malaseb shampoo twice a week, and half a piriton tablet daily

[k9diabetes]

Hi Tony,

Since she usually has a snack, I'm not worried too much about those lows at the vet when she wasn't given the extra food. I think you could back off a half a unit or maybe just a smidge - just fill the syringe not quite to the 8 mark.

I definitely would not want to change insulins - she's doing great on Caninsulin. Her blood sugar regulation is about as good as it gets.

When I think back to when you first came here... at the time I bet you never thought she would be doing so well.

This vet is giving you what is needed and everything else you have been able to sort out on your own, including the diet change. What a great accomplishment! :)

Natalie

[ajtony]

Hi Nathalie, You are so right but it wouldn't be going so well without everything we have learned from you and others on this forum, so thank you all once again. We changed to 7.5 units last night and will watch her like a hawk seen as we don't home blood testing. I'll have to post another photo cos she looks so much better now! best wishes, Tony & Jessie

[CarolW]

Hey, Tony - good that you dropped that half-unit. I DO test Kumbi at home, and it's when I chart the numbers that I see how dramatically food and exercise affect his BGs. I'm just working on charts now, and will be posting to Kumbi's thread.

It DOES seem to me that the reason Jessie dropped so low at the vet's was the omission of the food she usually gets! All the same, I do think it's safer to have dropped down that half-unit.

My own vet (I'm in Canada) puts quite a few of her patients on Caninsulin. She might have put Kumbi on it. I'm guessing the reason she put Kumbi on Novolin-NPH insulin instead was that I can't afford the Caninsulin! Fortunately, Kumbi does really well on the Novolin-NPH. I think that stuff has a different name in the UK.

Anyway, congratulations on your wonderful successes with Jessie!

Wed, 24 Feb 2010 19:59:54 (PST)

[ozzi]

Hey Tony,
First, I must tell you that I was happy to hear that you changed vets. You definitely do NOT want a vet who is unreceptive to questions taking care of your dog. So BRAVO on that decision! Second, just a caution on the diastix. I monitored my dog's "progress" by checking urine glucose and ketones. After his initial diagnosis, he was spilling a lot of ketones, and within two days of starting insulin, he went to negative and has never had ketones since. This is VERY helpful to monitor. Regarding urine glucose, this is much less helpful. For one thing, the urine glucose won't show a positive result unless the blood glucose is about 270 or greater. I felt it would be a helpful indicator of his progress, but it was my experience that it was not. As we increased his insulin to get him adjusted, the glucose went down, and we had negatives for about two weeks. I thought this was great. THEN, he started to show glucose in his urine, and at one point I brought him in for a blood sugar 6 hours after insulin and his BG was 70, yet the glucose strips showed 4+ sugar!! I cannot explain this nor could the vet. I only tell you about this experience so that if it happens to you, don't freak out! Especially in a dog who also has cushings. I still check Ozzi's urine glucose, mostly to watch for changes, rather than to rely on it as a measure of his progress. I have found that the only real reliable measure is the blood sugar. Having said that, I personally feel it's important to check for urine ketones...that is a much more sensitive test to show if a problem is starting. Good luck.
Kevin

[k9diabetes]

Hi Tony,

I saw you online and wanted to bring your thread up to the front. I was thinking about you and Jessie just the other day. Hope you all are well.

Natalie

[ajtony]

Hi Nathalie, Jessie is hanging in there but she is suffering with her recurrent skin problems again. I have to apologise for neglecting the forum after all the useful advice and support we received but we just have to get on with things and the weeks and months just merge into one long journey don't they?

Anyway, I can't even remember when I last updated you Nathalie. Jessie had surgery (at Glasgow vet hospital) on her ears to remove all the inner ear and that is just fine now - no more problems there. A few months later she had cataract surgey on both eyes and when she came home she could see me - it was very emotional I can tell you. She had about 3 or 4 months when she could see again but developed absesses and the long and short of it is that she is now 95% blind again. But she does cope with the blindness and that isn't a worry. She has been regulated for about 18 months now and has only ever had one hypo attack (about 2 months ago) - still on 7 units of Caninsulin. The shots are easy now and she just sits there as good as gold while we inject her. She has lost a lot of muscle from her rump/back legs (now weighs 7kg) but until recently has still enjoyed her daily walk and her food. The Nutritionist at Burns told us to reduce her food to about 80 gm of the High oats (she was on 125gm) and that was about 10 days ago. She also told us to try her without the natural yoghurt (as she says dairy products can cause skin problems) which we have - BUT she has gone downhill, especially her skin. It is sore, red and black - I am sure it is a yeast problem but don't know if it is linked to the diabetes.

We are going back to basics with her now and hence i was checking on the recommended diets on your forum. We plan to get a curve done in the next few days. We will give her 50 gm of Burns High Oats (she wont eat it unless we add some gravy or tuna) at 8am, and 7 units caninsulin. 1pm she gets a handful of chicken pieces, 1/4 cup natural yoghurt, 1 tbsp of Apple cider vinegar, 1 acidophillus tablet and 2 evening primrose capsules. 7pm she gets another 50 gms of High Oats, 7 units of caninsulin and a small chewy treat. She is also still on the Atopica tablets, 1 every other day but we sometimes make it daily. Now and again she will have a course of ABX.

So, she is 10 years old and has lasted 2 years longer than the Vet said she would. But she isn't very well at present and every now and then she gives out a little moan. She hasn't been out of her crate all day apart from a small walk, wees, and her food. But she isn't ready to go just yet and we will just trust in the lord that if she has to go He will take her without much suffering.

Best wishes to everyone on the forum.

Tony & Jessie in bonny Scotland

[k9diabetes]

Hi Tony,

Boy I didn't realize just how much the weeks, months, and years blend together until I saw the date of your first post!!! Holy cow - how could that have been two years ago?!?!?

It is really wonderful to get an update even if Jessie is struggling a bit right now. She's one of our wonder dogs and after all that you went through in 2009, it's all a wonderful gift.

Perhaps her skin problems are seasonal since it was December when you first came to the forum. I hope you find something that will make her feel better.

Wishing all of you good things in 2012! :)

Natalie

[ajtony]

Nathalie, Just ordered Douxo Calm Shampoo and Douxo Calm Micro-Emulsion Spray for Jessie's skin problem - it was recommended somewhere on this forum, so we will see how it goes. Must remain positive!! all the best, Tony

[CarolW]

Hi Tony and welcome back, from Kwali and Kumbi at the Bridge, and Camellia (not diabetic) and me here on Lowly Earth.

Camellia has been on the DOUXO shampoo and spray since early November, 2011, for a rather severe case of atopy, which doesn't visiably affect her skin, so she hasn't had the kinds of skin problems Jessie turned up with. BUT, she was scratching almost constantly, and worst, reverse-sneezing, which is absolutely miserable for the dog.

Also, she's been on antihistamines, all the time since about June, 2011. I'm now keeping her on Benadryl (diphenhydramine), giving short of 40 mg three times a day - if I don't keep up with this, she starts reverse-sneezing again.

Her thread, "Camellia Camelo," is in the Everything Else forum.

I'm bathing her weekly, and spraying twice-weekly, and even though I still have to keep her on the antihistamines, I believe the shampoo and spray are helping quite a lot.

I hope to heck they will help Jessie, too. If you have any questions about bathing and spraying, please ask, and I'll do my best to assist.

Mon, 30 Jan 2012 16:34:59 (PST)

[buddingartist]

Hi Tony
When I saw your post, I knew I had sent you a message and sure enough, it dates back to June 2010.

My little Buddy, also a Westie sadly left us March of last year. He had the same problems that you describe your poor little Jessie has. I experimented with so many different foods and treatments and managed to find the culprits.

Oats, rice, any type of grain, chicken (ironically if I gave him kibbles with some chicken as an ingredient, he could tolerate it but reacted violently to real chicken pieces). I tried the natural yogurt, the apple cider vinegar (both to clean his ears and paws) as well as in his food and it did not help. If you look at my picture album, you will see the kind of sores he was developing. His ears, paws, tummy were also black and he also had regular gum infections.

Amongst many other medical problems, Buddy suffered from both food and environmental allergies. I started feeding him grain free, supplemented by a bit of ground beef cooked and rinsed to eliminate fats, a mix of cooked and ground vegetables (cauliflower, green beans, spinach). I supplemented it with probiotics, Vitamin 3 and Omega 3.

I noticed that the food you currently have Jessie on is quite in carbs so if you decide to change it, you may have to adjust the insulin accordingly.

Within a couple of months, the number of infections were radically reduced and gradually his skin was pink again. I must say that part of our daily routine was to clean his ears and paws with Zymox, twice monthly bath him with Zymox and using the Zymox cream rinse as well. I also did a daily inspection of his gums and twice-3 times weekly teeth brushing.

Please understand that I am no expert (far from it) but I know what you are going through with your little Jessie and I just wanted to share my personal experience.

Good luck with your little one
Louise

[ajtony]

Hi Louise, thanks for the advice and sorry to hear about your Buddy! Jessie has really been through the mill with her skin problems over the years and when diabetes and Cushings were diagnosed we thought that was the end. The vet recommended she be put to sleep! We changed the vet and 2 years on her diabetes is regulated, and it turns out she didn't actually have Cushings at all (another mis diagnosis). Her skin condition is similar to Buddy in your album but a lot worse than the photos shown. We've just started on the Douxo shampoo and cream recommended by Carol and we are already seeing an improvement. We are also giving her a half a cup of brown rice with her lunch, and green beans and broccoli as treats and with her meal so we will see how she goes. all the best, Tony

[ajtony]

Hey Nathalie, Just had Jessie in for a curve at the vets and would appreciate your advice. She had 55 gms of Burns High oats and ten minutes later at 7am, 7 units of caninsulin. Here is her curve results:

9.15am 117
10.15am 165
11.15am 151
12.45 pm 86 then fed her lunchtime snack
1pm 138
2pm 160
3pm 181
4pm 199

She then has her meal at 6.30pm, 40 gms Burns High Oats, half a cup of brown rice, a few green beans, and then another 7 units of Caninsulin. She is allowed a dental stick snack after that.

My feeling is that the curve is just fine and there is no need to change the Caninsulin dose, but a second opinion would be appreciated. Her skin condition has improved a lot in just a few days. She weighs 7.05 kg. cheers, Tony.

[CarolW]

Delighted the Douxo shampoo and spray are helping Jessie! I didn't really recommend it, but reported that my vet did, for Camellia; it's helping her some, but Camellia still needs full doses of antihistamines (diphenhydramine - generic Benadryl) to prevent her from reverse sneezing. But she scratches a lot less than she did, and the antihistamines alone really didn't do the job for Camellia (not diabetic).

Hope Natalie has time to check in and remark on Jessie's curve. Myself, I'm nervous about running Jessie quite so low in her BGs, and I'd want to cut her insulin dose, say, by a half-unit, most likely, both morning and evening.

Also, it gets tricky when you're not feeding the same amount of the same stuff for both daily meals, and if it were me, I'd try to adjust that so she's getting exactly the same, morning and evening - would make it easier to make small tuning-up changes in insulin dose if need be.

But I'm badly out of practice now, and since I always had Kumbi on a totally consistent amount of food, and timing too (12 hours apart), and the same insulin doses morning and evening, I don't have the kind of adjusting experience that somebody like Jesse Girl has (or some of the others on this forum).

Natalie has the very best knowledge and ability to assess! So I hope she'll comment!

Hope the Douxo stuff continues to help! Camellia gets her bath today, and a spray about three hours later, when her coat is dry (I don't dry her except with a towel; don't have a dryer).

I have to sneak-prepare, to be able to catch Camellia to put her in her tub, so I'm going to wear my gum-boots for our walk this morning, and pop her into the tub when we return (at least; I hope things will go that way!) The other bath-stuff is ready.

Three cheers for you and Jessie!
Tue, 7 Feb 2012 08:41:02 (PST)

[Patty]

Tony, So good to hear Jesse is doing somewhat better!

That's a lovely curve. Not much room at 12:45pm to go lower though. I wonder if moving the lunch time snack to 11:45 or 12pm would prevent that dip in numbers.

I'm guessing the addition of brown rice and dental stick compensates for the lower amount of High Burns in the evening.

Keep us posted on the skin condition. We have so many that struggle with allergies.

Take care,
Patty :)

[k9diabetes]

What a stunning curve! :) Makes me want to fly to Scotland, take it to the first vet, and explain a thing or two!! ;)

I will have to pass on to Eliza the great news about Jessie's curve...

I could go either way with this curve. There is just the one level that's below 100 and it's nowhere near low plus the others are beautiful! I don't really want to give up the great levels the rest of the day for one level that's not far under 100 and well within safe limits.

So if I was managing Jessie I probably would just keep her at 7 units.

I agree with Patty that if her lunch could be moved up a little earlier, she might not drop so low so that's one solution to the concern about how much lower the blood sugar might go on other days.

The other "fix" is to add just a tiny bit more food to her morning ane evening meals rather than reducing the insulin a tiny bit. You can do finer adjustments with food sometimes than with insulin. But it's not predictable - the only way to know how it would shift things is to try it.

It's good that she's on enough insulin that a 1/4 unit change wouldn't be all that much of a change.

The short answer is that I think all potential plans are good ones, including leaving things as they are. Go with your instincts Tony and what is most comfortable for you.

Especially with her skin and allergy issues, I think tight regulation is probably helpful for keeping the other stuff under the best control possible.

Natalie

[jim maceri]

Great curve. You should be very proud and Jessie is one lucky pooch!!
Nice job.

[ajtony]

Thanks everyone for the words of encouragement! Jessie usually does get her lunch 15 minutes earlier (the vet nurse forgot and was a bit late) but we can definitely give it to her at 12pm so that seems to address that concern. As me and my wife both work we can't keep the food and shots exactly at 12 hour intervals but we try our best to be as near to that as possible. Some days he gets her am shot at 7am and other days it is 8.15am but her lunch is always 12.30pm. The nutritionist at Burns told us recently she should only be getting 70 gms of High Oats a day (she was on 110gms) so we compensated by reducing the evening portion and adding brown rice and green beans/broccoli to increase the carbs (I think that's right). Will keep you informed on her skin condition. Thanks again and all the best, Tony & Jessie

[buddingartist]

Beautiful is all I can say and happy to read that the skin problems are slowly getting better.

Louise

[Gooch]

Hi Tony,

Can't tell you how happy I was to get Natalie's email that you had posted and that Jessie was doing well. I've thought about you both over the (blimey, its been so long!) years.

I must agree that the curve looks splendid, though I would be wary unless I was testing at home with that low number but my girl was regulated quite tightly and clocked in regularly in the 90's, sometimes 80's and never had a hypo, mind you I tested her at home.

Sorry about the skin issues and really hope that shampoo continues to do the trick. I'm also glad someone with experience brought up allergies. It is alarming how many dogs have an allergy to something as innocuous as chicken or oats but there it is. For humans there is a a basic blood test to determine the allergy/ies and I assume a similar test would apply for dogs. Perhaps others can chime in too about this. It would be great to eliminate the culprit.

Well, you must be a tad chuffed considering the odds and many obstacles, I'd be for sure.

Take care and keep us posted.

[Shellie]

So glad to hear of Jessies' doing well! Looks like you might be just be into the 'tweaking' stage! Yay! Hugs!

[CarolW]

Wow; Eliza! Great that you checked in here! Thanks! What an honor! You don't check in all that often!

Tony - I thought Natalie's assessment was excellent, so I withdraw my suggestion of cutting her insulin dose by half a unit. Patty's remarks were good, too.

Sometimes, tweaking the food is the way to go!

P.S. Camellia didn't get her bath yesterday. Yikes! Got it today, instead; see her thread on Everything Else. The point, perhaps, is that we can't always schedule things perfectly, and I expect Jessie will cope well with whatever schedule you can manage! As a human CareTaker of my dog(s), I need to learn a bit more flexibility at times.

Wed, 8 Feb 2012 13:36:48 (PST)

[ajtony]

Thanks Gooch and everyone for the advice. Jessie is hanging in there. She is a bit more 'perky' lately and I can tell she is feeling better.

Jessie has only ever had one hypo (about 2 months ago), after her morning walk about an hour before her lunch and she quickly recovered after I rubbed honey in her gums.

Carol - we are shampooing twice weekly with douxo but haven't used the spray yet. How do you use it and when?

Also, I would be glad of some advice re allergies as we haven't really delved into that side, what with all the other issues Jessie has had to put up with. I am not confident in our local vet but would consider taking her back to the Glasgow vet Hospital for allergy testing, if I thought it would help. Any advice would be appreciated. cheers, Tony

[CarolW]

Tony - glad Jessie is feeling better. I'll give you links to help you with the DOUXO shampoo and spray.

Start here:

http://www.douxo.us/dermatology/douxo-dermatology-dogs-allergies-shampoo.html

And I'd scroll down and read the whole page.

Then, you can click on the Product Data Sheet on the main page there, for instructions on how to use the shampoo, and then do the same for the spray.

I find I can't manage 12 inches for the spray, and I talked to the DOUXO people about this. They said, that's okay. And because Camellia's coat is so thick and curly, they said I can use about three times as much as it says to in those Product Data Sheets.

It's a bit scary for us at first, but Camellia and I got used to it.

I think you're ready to start with the spray now. I bathe Camellia once a week, and spray twice a week. My vet wants me to stick with that schedule, forever, as Camellia is very sensitive.

So, first I wash, then I wait till Camellia's coat is dry, then I brush the coat against the lay of the hair, and then spray up into the hair, along her back, from tail toward head. I cover Camellia's head with a face-cloth, and hold it, to keep any spray out of the way of her head. And I'm applying it pretty heavily - about three times as much as that page recommends.

The spray takes about an hour to dry on Camellia. On non-bath-days, I spray the same way.

It's definitely helping, because we've now almost eliminated the reverse-sneezing that has made Camellia so totally miserable.

I was giving Camellia generic Benadryl (diphenhydramine), 1.5 25-mg caplets, three times a day, 7 to 8 hour apart. Lately i've cut it back to a single 25-mg caplet, three times a day, and still no reverse-sneezing (knock on wood).

My vet also suggested Cetirizine hydrochloride - that's a one-a-day caplet; we had started out with that, and though it seems to help some dogs a lot, it didn't help Camellia much. But that was back toward the beginning of the bad allergies and reverse-sneezing, which showed up last spring. Camellia will be five years old on 4 March this year.

We also tried her on Chlorpheneramine (also called Chlortripolon), 2 mg at a time (half a 4 mg tablet), up to three times a day, and that wasn't very effective for Camellia, either. But the Benadryl (diphenhydramine hydrochloride) seems to help quite a lot. So she was getting 37.5 mg three times a day, and now is getting 25 mg three times a day.

My vets say you can keep a dog really long-term on antihistamines.

Please let us know how things work out. It will probably take five to weeks of bath/spray before the missing skin barrier (phytosphingosines) gets sort of replaced. This is, of course, for environmental allergies of any sort.

I'll be REALLY glad if this DOUXO stuff works as well for Jessie as it's working for Camellia. Camellia doesn't like the baths, but she's very cooperative - once I catch her! See also her thread in Everything Else - under the title "Camellia Camelo."

So, keep us posted! And ask any questions; any I CAN answer, I will!
Tue, 14 Feb 2012 15:54:53 (PST)

[CarolW]

Forgot to say - I spray twice a week; once after the bath, and then approximately halfway between baths.

Tue, 14 Feb 2012 15:57:23 (PST)

[ajtony]

Thanks Carol, that's great advice. We've started on the spray but can't comb it in along her back as Jessie is almost bald here - we'll do our best. (will try and post some photos).

Re the antihisthimine tablets - we have been giving her half a prithrin tablet a day, these are the ones us humans use for hay fever and the likes. Do you think that is any use or do we really need it prescribed by the vet?

all the best
Tony & Jessie

[CarolW]

I haven't heard of that antihistamine, Tony, and don't know what it is. The ones my vet suggested for Camellia - three possibilities - are also antihistamines for humans.

They suggested:

Cetirizine hydrochloride, 10 mg caplets (once every 24 hours)

Chlorpheneramine (also known as Chlortripolon; I get it as Novopheniram - same stuff - generic); half a 4 mg tablet (2 mg) up to three times a day;

Diphenhydramine (generic Benadryl) - 25 to 40 mg up to three times a day; I usually give a 25 mg caplet and another half, making 37.5 mg, three times a day.

We tried the Cetirizine, but it didn't help much. Tried the Chlorpeneramine, ditto - didn't help much. The diphenhydramine seems to work best for Camellia.

Typically, my vets told me, dogs can take a dose that is normally set for humans- it seems, despite their usually lesser weight, dogs need more, relatively speaking, than humans do.

About the DOUXO spray - you could ask the DOUXO people about how to use it for Jessie, and I think I'd do that, in your place. I don't know about spraying it on an almost bald area.

You do NOT have to comb it in; it spreads on its own. = disperses itself around the body. The instructions indicate merely to brush the hair on the back against the lay of the hair; I think the idea is to get it on the skin. If Jessie has sore spots on the skin on her back, I'd want to talk to DOUXO about that.

I think they have a Contact Us place on their web site; you might try that.

Wishing you a ton of luck with it!

Fri, 17 Feb 2012 19:45:30 (PST)

[CarolW]

Forgot to say, Tony - I'd check with your vet on the antihistamines. We can get all three I mentioned, without a prescription, from the pharmacy (chemist).

Fri, 17 Feb 2012 19:50:25 (PST)

[farrwf]

Re the antihisthimine tablets - we have been giving her half a prithrin tablet a day, these are the ones us humans use for hay fever and the likes. Do you think that is any use or do we really need it prescribed by the vet?

all the best
Tony & Jessie

I use either Chlortab (Chlorpheneramine) or generic Benadryl for Otis' allergies. Seems he'll develop a tolerance to one then I switch to the other for a while.

Both are OTC no prescription and are very cheap at Costco.