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pgcor
01-19-2009, 06:34 AM
Hi Everyone!

I'm very excited to be here as Natalie was so, so kind to Pip and I when he was first diagnosed. That was a year and 5 months ago!

We started with W/D and Vetsulin (7 units) and he did okay for awhile, but he had bouts of high blood sugar that were not explained. We thought Cushings for awhile, but the Vet put that on the back burner for now.

With the help of Carla, I switched Pip to Humulin N and he now gets homemade food. I've had to steadily increase his food as he lost a considerable amount of weight. He also dropped his insulin requirements with the change in food.

He gets 7.5 oz. of turkey or chicken (ground) and 5 oz. each of ground zucchine and ground green beans, 1 oz. of ground chicken hearts and 4.5 oz. of pumpkin. He's at 5.5 units of Humulin N. Actually, he's more stable than ever on the new food and insulin - so THANK YOU CARLA wherever you are!!!

Over 2008 he's had eye problems. He gets tacrolimus once a day and another "aspirin-type" drop (as the Vet describes it) once a day as well. I can't remember the name of the drop though.

He sees an eye specialist for this. And if he remains free of ulcers they won't need to see him for year. Fingers crossed!

I haven't been able to blood test him at home, but we remain vigilant about testing urine. It may not be accurate, but coupled with his behavior, it does let us know when he's unwell.

Lately, he's been showing sugar in his urine (usually he shows none) and has been vomiting (a little). So, we are calling the Vet today to check him out.

Hopefully it's not pancreatitis again. He NEVER gets anything other than his food and diabetic dog treats. So, I get nervous that maybe he's one of those dogs with chronic pancreatitis. He's had it 3 times since diagnosis.

Anyway, it's been a long haul getting me comfortable with his diagnosis! (It's all about me). But, I'm nowhere near the hysterical point I was a year ago. I never, ever though I could stick a needle in my beloved Pip! Isn't progress wonderful!

Hugs to all! Pam and Pip

Debbie & Apollo
01-19-2009, 07:51 AM
Hi Pam and Pip,

Your Pip sounds a bit like Apollo...we even did the Cushings tests..... however we are still using Vetsulin....
anyhow -- do you give Pip any supplements?

I have been giving Apollo - SamE (Denosyl), and Milk Thistle.
both are good for the liver etc... and since we too have a history of pancreatitis - anything I can do to prevent .... it's worth it!

another thought -- Apollo gets 'hungery' and at times he will eat too fast -- that's usually when we might see a bit of upchuck:) I stand by his food now to slow him down and I also put his food on a larger plate and spread is out to help the speeding.

hope the vet appt goes well.

Debbie and Apollo

birdk
01-19-2009, 08:35 AM
Hi Pam and PIP.....Hope the vet visit goes well and Pip is on the road to recovery.....

pgcor
01-19-2009, 10:05 AM
Hi Kay and Debbie!!!

I will let you know how the appointment goes. Debbie, I forgot to mention that Pip is on Denosyl and Sam-e. I'm getting so forgetful as I get older. I have to have a list of his foods and supplements in front of me - everday - or I'm afraid I'll forget something!

Pam

eyelostit
01-19-2009, 11:36 AM
Hi Welcome,:)

Nat and Kath are the greatest, Nat helped me with Niki alot back at DX.

I hope with Nick it was just an up chuck thing. Changing or adding food etc, is always hard on me and Niki

Niki has lost enough weight to have me concerned, so I am working with new diet and insulin, not easy as you know.

You've come a long way, good job ;)

birdk
01-19-2009, 12:09 PM
Pam sounds like you are fighting dry eye like I am with Nick. Nick is on cyclosporine drops. I also had him on antibiotic ointment and then some lubricant in between times. His eye is puffy around it. The other eye looks fine. The infection looks much better but I am trying to figure the puffiness. I read about it this am of Marvistavet but now forget what I read!!! Oh age and menopause!!!!

pgcor
01-19-2009, 02:12 PM
Hi:

My husband just came back from the Vet and first of all Pip lost weight again. I can't believe it! He was doing so well. He actually gained a pound. He has been acting like he's starving lately - and that could account for the vomiting. He eats like it's his last meal.

Secondly, at about 3PM his bg was 66! The Vet didn't want us to drop his insulin, but give him more food. I have suspected that Pip might go low at the Vet because of nerves, but I have no proof.

I'm worried about 66 at 3 because based on previous curves, his lowest time of the day is usually noon.

He has not shown signs of hypoglycemia that I've been able to detect, but he never has actually gone hypo. My husband is home with him all day.

I'm quite depressed with this news - I just hope tomorrow isn't more of the same.

Pam

rhodesian46
01-19-2009, 02:30 PM
Hi Pam
Glad u came over here. I would test urine at fasting tonight and test before you go to bed. What time does Pip get his eve shot? How much more does the vet want to increase his food?I forgot does Pip bite Is that why u don't home test?

Brandy mom
01-19-2009, 05:59 PM
It could be the excitment from the vet. Brandy will drop like a rock at the vet. I give her treats before we leave and at the vet. Some dogs BG get higher at the vet some lower. Each dog is different.

With more food this should help raise the BG tomorrow. The low of 66. Is that why the vet wanted to increase the food and not the insulin?

Dawn and the girls

pgcor
01-19-2009, 06:25 PM
Hi Marianne and Dawn:

You guys are everywhere! But glad to see you too Dawn!

I've never been able to get blood from Pip because it requires milking the site and he won't stand for that. He does bite and he's a horrible fighter. We've even wrapped him up like a papoose (sp?), but he actually seemed to foam at the mouth from fighting so hard. So, I've given that up for now. I'm hoping he will relax a bit as he gets older.

The vet said more food because it looks as though Pip has lost about 1 lb. again - not because of the 66. I just don't know how he could have lost weight again. He's been on this amount and type of food for at least 2 months and had gained weight. Now he's down again. Could be the scale, but a pound on him is a lot of weight.

Dawn, I think you're right, he might go lower at the Vet because he's never exhibited any hypo symptoms.

My husband called me from his cell phone and was very down and disgusted about Pip. I guess I caught a "contact low" from him. Sorry.

k9diabetes
01-19-2009, 09:05 PM
Aw... don't feel down! Pip's regulation has obviously been pretty good since there's been no glucose in his urine tests until recently.

I wouldn't be surprised if the vet visit contributed to the 66 - Chris' blood sugar always dropped at the vet; similarly he wasn't ever one to rebound. His system just didn't do panic glucose releases much.

How much time has passed between the two weighings?

That would give an idea of how rapid the weight loss is, which makes a big difference in how severe it is.

Has the glucose on the urine tests been a lot or only a little?

Any pattern to when it shows up?

As in does his urine go negative a few hours after his shot and then show glucose later in the day - potentially rebound - or is there a little glucose in all of the urine tests?

What is the status of his eyes right now? Could infection or inflammation in the eyes be driving the higher urine tests?

Definitely you'll want to give him more food and whether the insulin should increase too depends on what you can sort out about whether he's rebounding or needs more insulin to maintain his regulation. Answers to some of these questions might help us figure out which one it is but the 66 at the vet suggests that rebound is possible.

If it is rebound, upping the food without upping the insulin could get you back to better regulation. If it's not rebound, then upping the food but not the insulin should drive even more glucose into the urine throughout the day. Either way, increasing the food but not the insulin could help clarify things along with more detail about what you've been seeing prior to now.

Anxious to hear more (and hope you feel a little cheerier!),

Natalie

pgcor
01-20-2009, 11:41 AM
Hi Natalie:

I have to say, I'm getting pretty forgetful lately (it's a little scary at my age)! But, here goes:

Marianne: his urine was about 100 last night before we went to bed.

Increased food by 20% - fasting urine this AM was 250; at 10:00 it was 500 and he went negative at Noon. He usually goes negative by 8:30 - 9:00. Natalie, before this, once he went negative he stayed negative until his next shot. I'll have to see what it is today when I get home.

The time between the two weighings was about 1 to 1.5 months.

His eyes were fine at his last eye doctor check-up at the end of December.

Am anxiously awaiting the Vet's call to see what his chem panel says. Once I know what that says I can schedule a curve. It looks to me though that he was probably getting the right insulin and food before he went out of regulation. He has been acting "extremely" hungry lately and one of us has to hold him until his food is made. His barking is so bad and he quite literally gets hysterical. (Just like his mom!) Actually, there are times when I have not been unable to hold him - hubbie is stronger.

I just have to say one teeny little thing I HATE THIS. Okay, done. But, we do think Pip is trying to kill us so he can inherit "the estate" and get rid of Newman (our other dog).

Ricksma
01-20-2009, 12:04 PM
Hey Pam!! I am keeping my fingers crossed that Pip's lab work is normal. Even though the 66 was low, it is still "within normal limits", and if you take into account that it might have been stress, and his actions at other times have never indicated hypo, I'm hoping that this is just a fluke. You know how I feel about MinPins, and Pip is just being Pip....he's just "high-spirited". Let us know how the bloodwork turns out..

Love and hugs, Teresa and Ricky

pgcor
01-21-2009, 06:03 AM
Good Morning Everyone!

Well, Pip does not have pancreatitis (WHOO HOO), but my husband, in his wisdom told the Vet to only run the specific test for pancreatitis, so I was surprised when I picked up his lab report last night.

He was 31 on that test and anything under 200 is okay. I'm disappointed because I would have liked to have seen liver and kidney values. But, my husband is very concerned about money....so.

Pip did not vomit yesterday, but his urine has been mostly positive for sugar and that's high for him. He also had to go out at 4AM, so I tested his urine and it was 100 on the Keto Diastix. It was the same at 6AM too.

I work, so I asked my husband to check his urine today as often as he could. Who knows what that will be.

The vet said to leave him at 5.5 units today and see if he goes negative at all. If he doesn't she wants me to increase by 1/2 unit tomorrow.

Pip weighs 21 pounds again and this is what we're feeding him now:

9 1/4 oz. of chicken or turkey (ground)
6 1/4 oz. of zucchini (ground)
6 1/4 oz. of green beans (ground)
1 oz. chicken hearts (ground)
2 3/4 oz. of pumpkin

This seems like a lot of food for Pip. Hopefully he gains weight on this amount. He should be at least 23 lbs. according to our Vet.

Natalie - I read your response about a dog's reaction to going to to normal ranges after having high sugar. I didn't know that and always thought that Pip was sick because after his shot he always seems to be so tired. Now that he's running higher he's more hyper than usual. If you can believe it, and I guess that's why I think he seems better at higher sugar. Boy, you really have to know a lot to judge a diabetic dog by sight. Not always reliable.

k9diabetes
01-21-2009, 08:21 PM
urine was about 100 last night before we went to bed.
fasting urine this AM was 250;
at 10:00 it was 500
went negative at Noon.

He usually goes negative by 8:30 - 9:00.
before this, once he went negative he stayed negative until his next shot.
The time between the two weighings was about 1 to 1.5 months.

His eyes were fine at his last eye doctor check-up at the end of December.

Well, I think you shouldn't worry too much as it seems that Pip is still staying fairly close to the renal threshold so his blood sugar isn't terribly high. From your description, I don't think he's been rebounding.

The weight loss was rapid... does it coincide with the food change? If so, then it's probably just an issue of not enough calories.

I just have to say one teeny little thing I HATE THIS. Okay, done. But, we do think Pip is trying to kill us so he can inherit "the estate" and get rid of Newman (our other dog).

LOL... our cat Katie thought she about had things handled when Chris passed away. She'd gotten rid of the evil cat Winky and then Chris, who she liked okay but you know... he's competition. So that just left Gus and he's not all that well. She was quite insulted when we brought Jack home. I will say though that she knows better than to try to kill me... I'm the supplier of all good things!

Natalie

k9diabetes
01-21-2009, 08:24 PM
Boy, you really have to know a lot to judge a diabetic dog by sight. Not always reliable.

This is why I despise UCD's current idea of monitoring regulation - watching thirst and urination and weight only....

eyelostit
01-21-2009, 09:36 PM
I'm glad no pancreatitis, :)I really feel bad for all our members who have to go thru this.

I can relate to how you think its so much food, as I have been doing with Niki, i look at it and think "I could not eat all of this in one sitting" but I guess dogs can handle it, they would eat and eat.

Don't feel down, and oh the forgetting, isn't this fun just one more thing in my way. LOL;)

pgcor
01-22-2009, 05:47 AM
Good Morning!!!!!

Well, Pip was negative on his urine tests all day yesterday. All day meaning:

6:00 AM
9:00 AM
10:30 AM
2:00 PM
4:00 PM
5:00 PM
9:00 PM
10:30 PM

Didn't my husband do well? Finally I put the fear of God in him. LOL

Anyway, this morning he tested at 1000 on the Keo Diastix! His insulin has not changed and he's getting more food. So I really don't get that.

I think I should give it at least 2 more days and then see where he is. I want to schedule a curve, but not until he settles down.

pgcor
01-22-2009, 05:52 AM
ooops I forgot to say thank you to everyone for their advice and help! Dolly, I'm really getting bad with my memory.

Over the weekend we had to contact the Vet in an emergency because I put the Digestive Upsets drops in Pip's eyes rather than the flubiprofen. Luckily nothing happened to Pip, but I thought OMG, what have I done?

I don't know what's happening to me, but it's scary because my Mom and all of her sisters had some form of dementia.

All I can say, is that if I have to get that - I hope I forget how to clean the house first.

Ricksma
01-22-2009, 05:55 AM
Oh Pam...that was priceless...there are some things that I want to go first, too! Like, um, I don't know....knowing what my ideal weight is? LOL You crack me up!

Love and hugs, Teresa

pgcor
01-22-2009, 08:30 AM
Oh Teresa - I had my weight officially "done" in High School. I see no reason to repeat it.

Patty
01-22-2009, 09:47 AM
Oh Pam...sorry you had to go through that. But Teresa's right, that was priceless.
Glad for the negative pancreatitis report yesterday.
Patty

k9diabetes
01-22-2009, 10:27 AM
If you get another very high urine test first thing in the morning after all negatives the day before, I would consider the possibility that Pip's blood sugar went too low overnight and caused some rebound.

You might consider a small reduction in the nighttime insulin to be safe.

Trouble with urine tests is it's hard to know if the nighttime dose is too low so there's sugar spilling over or too high so causing some rebound.

Too much insulin is the more likely possibility and the one with the most risk for Pip so I'd opt for the possibility that his insulin at night needs a slight reduction and see if that helps.

... there are lots of things I'd like to forget!

pgcor
01-22-2009, 11:07 AM
I agree with you Natalie. But, don't you think it's odd to have rebound now? Especially with an increase in food?

I will definitely drop his dose at night if this continues though.

Thanks Natalie, Teresa and Patty!

eyelostit
01-22-2009, 05:49 PM
.

All I can say, is that if I have to get that - I hope I forget how to clean the house first.

I have forgot somewhat :D

k9diabetes
01-24-2009, 07:48 PM
Could be it's just one of those off-the-wall variations that defy explanation... time will tell!

pgcor
01-30-2009, 10:06 AM
Hi all!

I know that you will indulge me here as I'm really quite down in the dumps with Pip.

Since we increased his food about 2 weeks ago, I have not been able to re-regulate him. I don't blood test at home, so I know you can't really offer an opinion.

Pip was supposed to have a curve done yesterday, but unfortuately our refrigerator broke and we spend 1/2 a day trying to get another one and get his food and medications properly stored.

Secondly, it looks like he's gained some weight (weighing him on a home scale), so I think I'll have to scale his food back fairly quickly.

He was at 5.5 units and is now at 6.5 units and we still haven't seen one negative on his urine check.

In desperation I called the Vet and we'll schedule a curve for Monday. I don't know how good it will be because I'll be scaling food back soon - but I don't know what to do?

I really have tried to get blood from him, and at times like this I could just cry. I wish one of you could visit my home and see how he is. If for no other reason than to just alleviate my guilt today.

Oh, how I wish there was a magic pill....:(

We Hope
01-30-2009, 12:03 PM
First of all, how high is the urine test positive, according to their color scale?

You can also set up to monitor urine 3 times a day using the Intervet tables here:

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

1. Have pet owner test urine three times a day: before the first meal (test 1), before the second meal (test 2), and late in the evening (test 3).

A table is below this and it indicates what action to take if the reading is positive, negative or trace at what times of the day. According to the table with all positives, a curve is suggested.

Those on insulin can gain weight even if nothing about their eating habits have changed.

http://www.mayoclinic.com/health/insulin-and-weight-gain/DA00139

"What's the connection between insulin and weight gain?

"Weight gain is a common side effect for people who take insulin. The more insulin you use to control your blood sugar level, the more glucose that gets into your cells and the less glucose that's wasted in your urine. Glucose that your cells don't use accumulates as fat. If you continue to eat as you did before, you'll likely gain weight when you start taking insulin.

"Think about it this way: Before you start taking insulin, you may be able to eat more food than you need without gaining weight because your body doesn't use the food properly. But when you start taking insulin, all bets are off. When your body uses food properly, you may need less food than you think."

We had Lucky on the same amount of W/D canned since starting with it. We didn't need to make any changes to the amount of food even when he was fully regulated on the old Lilly Iletin II Lente or when we were forced to use Iletin II NPH for about 2 months.

After getting onto Caninsulin/Vetsulin and regulating, we had to cut back the W/D because with nothing being changed except the insulin itself, he had gained weight because his body used the U 40 pork Lente much better than it did the U 100 pork insulins.

Leaving the insulin alone at the same dose but cutting back the food did the trick very nicely and very quickly. He'd gained 1/4 pound (small dog) and that was enough to make for somewhat higher than usual bg's. After the 1/4 pound "extra" was gone, he went back to his same reliable, steady pattern of bg's.

I'd go with the Monday curve, see what the results of it are, and have a talk with your vet re: how much to cut back on the food. I think that should get things back to normal in a short period of time.

Kathy

pgcor
01-30-2009, 12:52 PM
Hi Kathy:

I didn't explain myself - but I never do because I'm such a hyper lunatic! I'm sorry.

I've been trying to get Pip's weight up. He has been very under weight since I switched to home cooked food. I thought we had him at a good amount and he seemed to be okay, but the last time we were at the Vet she said he lost a pound and to increase his food. Since then, all bets are off.

So, not only is he getting more food, but he seems to weigh more by our home scale.

He's usually around 500 when we test him pre-meal and shot. He has been higher, but not often. More often he's lower.

The Vet can't take Pip for a curve till Thursday now. Too busy...:(

I've asked this question before, but I'll ask you - do you think it's okay to force a dog to get blood?

We can wrap Pip up like a taco and then I can get blood while my husband holds him. He absolutely freaks out when we try that though. He's the same way at the Vet, but I figure it's okay if he doesn't trust her.

We Hope
01-30-2009, 01:21 PM
OK, you wanted weight gain and it looks like that has happened. Most of the time weight gain that you intend to "keep" will mean more insulin because you base insulin on X number of units per kg (2.2 lb) of body weight.

You did increase from 5.5 to 6.5 units--don't know when you did but it can take 2-3 days or more to see any results from an insulin increase.

http://www.childrenwithdiabetes.com/...as_insulin.pdf

Page 10

"the size of the insulin depot makes it necessary to allow 2-5 days of adjustment before achieving a new equilibrium."

Here's where some people get impatient because they expect the increase to act almost instantly and they start increasing at a too rapid rate. This is how rebound gets set up--by not waiting long enough or doing too large an insulin increase at one time.

My personal feeling is no on the forcing blood testing. We elected not to home test because both of us knew Lucky. In the beginning, he was trying to hide from me when it was shot time. We were afraid that if we started doing blood testing, we would lose his necessary cooperation for those two shots a day.

While he got over the hiding at shot time to the point where he'd come into the kitchen after eating to get his shot, we still both believe we would have had no chance at giving the two shots a day without stress had I been poking him more than twice a day.

Lucky was professionally tested at least once a week because John is like family to me, so the additional costs weren't a problem. We tested him on different days and different times-for Lucky, we had an excellent picture of what was going on with him. When we were working at regulation or trying to decipher a "bump" in the road, he was tested more often than that.

Lucky was fine with this with all but one associate--when she drew blood, you would see 50+ points in the reading. Nothing bad happened between them; he somehow just didn't care for her. All the rest were his buddies and stayed that way even if they drew blood from him, but I don't believe he would have stood for two shots a day and home testing both.

With forcing Pip at home on a regular basis, I would be concerned about what this everyday stress might do to him. True, it's done periodically at the vet but having someone do this doesn't happen every day.

You might also be putting everyone's effort into this for naught if Pip is the type whose bg's go up or down at stress time; if he goes either way--up or down--you are still not getting what you hoped for with home testing, and that's a true picture of what his bg's are doing when not at the vet.

It sounds like things aren't that bad for Pip because you've been feeding him more and he's gained the desired weight from that. Needing more insulin because of a wanted weight gain isn't anything to be stressed about! ;)

Kathy

k9diabetes
01-30-2009, 01:48 PM
I totally agree with Kathy - there's no good to come of stressing you and Pip forcing him to have blood glucose tested. Yes, it's a great tool BUT it's not for every dog and it's not absolutely necessary.

It's like cutting wood with a power saw or a hand saw. If I've got a power saw, it will be a lot easier for me to cut up a 2x4. But it can be done with a handsaw and was done that way for years before there was any such thing as a power saw.

If all his urine tests are staying around 500 or mostly under 1000 and he's gaining weight and not drinking and urinating excessively, I think things are good. His blood sugar's not going all that high and, as you said, there will be another food adjustment so probably no need to get a better handle on this current situation.

Is his weight good now?

If so, you could cut back to an amount half way between this amount of food and the amount of food he was losing weight on and see how his weight does on that. Keep the insulin the same or decrease it half a unit and see how that goes.

You know, in all the years I've been on these forums, one of the most difficult experiences for the person is a dog who was very well regulated at first and then loses that regulation. Because you feel like you have failed somehow... (hint: you haven't and your dog hasn't!)

While those of us whose dogs had horrible regulation at first or for a long time just kind of got used to our dogs having high blood sugar!

Not that we like it, but we are accustomed to it and it doesn't freak us out.

If Kay stops by, she will back me up on this one. Bo had great regulation for a long time and then his other health issues started wrecking havoc with his blood sugar and it was really difficult for her to "lose" the well-regulated dog. It's kind of like starting over again and you go through some of that new-to-this freaking out.

So I say celebrate his weight gain! Because that really is wonderful news and you've accomplished it fairly quickly and without any terrible high blood sugars.

This is just how it goes with diabetes. Things change and you work out the best solution you can to handle things until they change again. Because they WILL change again sooner or later.

I can see that you are very hard on yourself in all of this Pam... sometimes people who are very hard on themselves should NOT test blood glucose even if their dogs will let them... more information is not necessarily calming! ;)

I'm very excited to hear that Pip's put on weight so quickly! That's a great indicator that his health is good and he just needed more calories.

Natalie

pgcor
01-30-2009, 02:14 PM
THANK YOU KATHY AND NATALIE!!!!

How funny that you should notice my neurosis? I keep it so well hidden! Thank you for helping me put things into perspective.

Pip is at 23 lbs and that's where the Vet said he should be. You can't see his ribs so readily anymore. Only when he's laying down. My husband and I talked about cutting his food down between 10 - 15%. Before the weight gain we had boosted his food by 25%.

I intend to lower his insulin to 6 once I lowered the volume of his food. I'm very afraid of hypos.

But I think this is a good plan.

Ricksma
01-30-2009, 02:21 PM
Pam...we know how much you like to beat yourself up, but it sounds to me as if Pip is doing great. More an occasion to have a party than a whipping!! I know you have always felt badly because you can't test Pip, but I think I have told you before..don't. You are doing an outstanding job, and like Natalie said, things were done this way for a long time. Butchie was diabetic for 10 years, and the only thing we ever did was urine test. So...take a deep breath, and enjoy the extra weight.

Love and hugs, Teresa and Ricky

rhodesian46
01-30-2009, 03:57 PM
Pam.
I agree You are too hard on yourself. I wouldn't force home testing on Pip. Pip is just that type of dog that hates that. I don't think you are a terrible mom for not testing. Some dogs are just easy to do I could get my meter out Pebbles would lay down and flop on the side of her callous. She was smart After all she was my pin cushion!I am sure that you have tried everything to try to test.MAybe one day you will succeed If not you can use the urine strip

BaileyBear
01-30-2009, 06:53 PM
I know I'm new to all of this, but just wanted to agree with the others not to be so hard on yourself about Pip being so fearful of BG testing. I just got lucky with Bailey not minding it at all. He is one of the odd balls who just lays right down on his side with his lip of choice for the moment and doesn't bat an eyelash. Pure luck.

But I had a border collie mix who was PETRIFIED of getting his nails trimmed. We had him since he was a very young puppy and he hadn't had his nails trimmed before, so we knew it wasn't due to any terrible experience he had. They couldn't even do it at the vet's without sedating him. It was like we were all trying to remove a limb. Thankfully his stayed in decent shape just from walking on the pavement and the occasional game of chasing a tennis ball around the court. But sometimes we had to have his dew claws trimmed.

It sounds like you are doing such a wonderful job of caring for Pip and monitoring him in other ways. Neither of you need the stress of dealing with something that makes him so fearful and you so distressed. You need to give yourself a pass on this and a huge pat on the back for everything else you do to give Pip a happy, healthy life. :)

BestBuddy
01-30-2009, 06:54 PM
Hi Pam,

I can so totally relate to how you feel. It took me 4 years to get the courage to buy a meter and attempt to test Buddy and then it was several weeks before I managed and that was with a lot of screaming and howling and that was just me! I always judged Buddy on how he was acting, both eating and toilet habits and of course the urine strips.

I had my hand forced with the BG testing because of another health problem (cushings) and the medication to treat it. I really don't know if we would have ever tried otherwise.

I do know it is a great tool if it can be done but if it can't you make do with what you have.

Jenny

eyelostit
01-30-2009, 09:21 PM
Pam,
Don't down yourself, this journey we are on gets so crazy at times.

Oh I know about the Nail trims, Niki is about 3/4 border collie, oh my its like I am killing her!!

I know its very hard for you to test but a thought is have you ever tryed a poke with the 31 gauge needle? Just a little poke, sometimes the lancets are so thick.

And if you can't home test thats OK, alot of members cannot do this, we all do the best we can.;)

Chin up !:)

pgcor
01-31-2009, 09:09 AM
Thank you everyone for your words of encouragement. I can't tell you how much they mean to me! They do keep me going! I'm 55 years old and still full of Catholic guilt!!! LOL

The good news is that Pip tested 250 on his urine test this AM at 10:00 which is lower than it has been. So, I'm very hopeful that he will be negative by noon. That will be his first negative in almost two weeks!

I'll be cooking his food today and will reduce by 10%. He should be ready for his curve on Thursday.

I don't want to sound trite or flippant - because the support I receive here is so important to me. Sometimes I don't see the forest for the trees. I am truly, truly grateful for the time all of you take out of your day to help me!

Pam and Pip

Ricksma
02-01-2009, 05:50 AM
Pam, I know just what you mean...sometimes it is easier to truly see better from a distance.....and you are very welcome!!! You are doing a wonderful job, mom....you're the best.

Love and hugs, Teresa and Ricky

eyelostit
02-01-2009, 09:13 PM
I'm 55 years old and still full of Catholic guilt!!! LOLPam and Pip

LOL, I started sheding the guilt sometime back, those nuns really pounded things in my head!!! The kids nowdays have it pretty good, they have no idea of back then.;)

k9diabetes
02-04-2009, 10:35 PM
How's Pip doing?

Natalie

pgcor
02-05-2009, 08:13 AM
Hi Natalie:

I'm really, really confused with him!!!!!! Today is his curve. We have not gotten any negative readings on his urine test for about two weeks.

First draw at the Vet was at 7:45 and this was fasting and no insulin and a full two hours past his 12 hours - 97!

Next draw at 10 - 49!

I know he can drop from being nervous, but how are we supposed to know how to adjust his insulin? These are really low numbers that do not correspond to his urine tests. I know that bg and urine are different, but at these numbers he should not have showed any sugar in his urine!

I'm just shocked at these numbers. I only wish my husband could have checked his urine because that would have confirmed to me that he was dropping due to stress, but as usual, he was unable to get it. I could kick myself for not getting urine this AM before I went to work. But I didn't want to get Pip up because he can't eat. Better to stay in bed with my husband. Or at least that's what I thought.

Well, we have the rest of the day...but geez :confused:

Pam

We Hope
02-05-2009, 09:08 AM
Pam,

First of all, if Pip is getting a curve done without food and insulin, what you are not seeing is the blood glucose elevations which come from whatever one eats, so you're really looking as his basal--body's needs without bringing food into the picture. You more than likely are seeing some stress response while there factored into it also.

What you are most accustomed to seeing is Pip's urine tests when he eats normal meals, the food we eat is a lot of what drives bg's up and that's where the insulin has to come in to control them.

In the years before insulin was isolated, there was nothing you could do to try to keep people with diabetes alive except to put them on what was known as a "starvation diet". It was known that the food they ate would drive their blood glucose up because of their non-working pancreases, so they were to eat just about enough to keep alive. After insulin was available, those with diabetes were able to enjoy a more balanced diet because they could eat sensibly and use the insulin injections to keep their blood glucose controlled.

The body requires some insulin to stay healthy (Which is why we always are talking about the need to give some insulin even when the pet either doesn't eat or eats only part of a meal.), but the real "bulk" of the job the insulin does is to handle the food that's eaten.

http://images1.wikia.nocookie.net/petdiabetes/images/2/29/White1.gif

This is an illustration of the insulin secretion of a person who doesn't have diabetes. Where you see the "spikes", note that they come in response to having eaten a meal. Those very low levels of insulin secretion you see are in response to the body's basal need for insulin. If we vary our thinking just a bit and view the graphic in terms of diabetes, I think you can see when and where the real "demand" times are to have substantial amounts of insulin--after meals.

Now let's go a step further and try to look at the graphic in terms of it being blood glucose levels instead of insulin secretion. The process of higher blood glucose levels begins at about 2 hours after eating; this is when most people with diabetes check their blood glucose to see how they're doing and if they might need a small corrective dose of fast or rapid insulin in addition to what they had used to cover the meal.

If one ate little to nothing, there would be very few problems with controlling blood glucose levels. :)

What you might want to share with your vet are your records of Pip's urine test results. This is some way to view what he's doing when things are normal and food is added.

For the most part, what you are seeing when you do urine testing is "delayed reporting results".

http://www.pueblo.gsa.gov/cic_text/health/noninsulin-diabetes/check.htm

"However, urine testing is not completely accurate because the reading reflects the level of blood glucose a few hours earlier."

Basically, then, what you're seeing re: urine readings would have been present in his blood earlier if you had tested it. The reason blood testing is preferred if possible is because it gives you an "up to the minute" look at the amount of glucose in the blood at present, while urine test results are "slightly old news". ;)

These home urine test results might be helpful to your vet by way of comparison of them against the hospital curves.

HTH!

Kathy

pgcor
02-05-2009, 09:30 AM
Hi Kathy:

We like to get a fasting bg on Pip at the beginning of all of his curves. It's the only time we test his blood and then we can compare his fasting number in the AM and PM to make sure he's on track. Is that not something you would do?

Even considering the delay in urine - based on the 97 blood test, wouldn't you expect his fasting urine tests to have been negative?

I thought there would be at least some correlation between the fasting urine and bg test. If you're below the renal threshold you should be negative, no matter what test you use. Am I correct in my thinking?

I'll post the rest of the curve as it comes in. I wish I was home and could bring Pip to the Vet myself. I told my husband to bring in the urine results, I'll have to see if he does it. (Doesn't like being told what to do!)

Thank you so much for all the information Kathy!

Pam

We Hope
02-05-2009, 10:03 AM
Pam,

I would believe that if you'd done a urine test for Pip this morning, you would have gotten a negative too.

If you're below that renal threshold, as you said, you would be below it whether you were testing urine or blood. The glucose starts going into the urine at the "threshold" and will be seen if you pass that point and stay there for a while. While your urine stick will show a negative, using a meter would put you somewhere below 180 mg/dl.

If Pip's urine tests didn't make it there, you might be able to send them to your vet via fax rather than "via DH". :)

We'll be waiting to see what Pip's willing to tell all of us!

Kathy

k9diabetes
02-05-2009, 11:43 AM
It may be that curves are just too stressful for Pip. In which case you might as well skip them and save the money! (well, and the stress too, of course!)

This is the one time when a fructosamine test may be of some value. It could potentially confirm your urine test results.

Otherwise, I'd just stick with urine tests and see what you can do working at the "edge" of the threshold for glucose spilling into the urine.

If you start getting negative tests, you can drop back just a tiny bit on the insulin - estimate a quarter unit if necessary - and see how that affects the urine tests.

If more sugar immediately shows up after such a tiny reduction in insulin, then you can figure that his BG is hovering close to the threshold.

If the urine stays negative, drop it a tiny bit more and test again.

How much you have to drop the insulin to push his blood sugar back over the renal threshold can give you an idea of how far below it he has been while testing negative on the urine strips.

Then you can adjust with a permanent slight drop in insulin if he seems to be running too far below the threshold.

Hope that makes sense.

You can do sort of the same thing in reverse. If his urine tests always show a small amount of glucose, increase the insulin very slightly... like a quarter unit... and see what that does. If the urine tests drop to negative from a tiny itty bitty increase, he's probably been hovering somewhere around the threshold. If it doesn't drop to negative glucose, he's probably been consistently higher than 180 throughout the day.

Curves are nice but they aren't necessary. Pip wouldn't be the first dog for whom even curves are impossible. So you work with urine tests and whatever signs he shows you and go from there! It sounds like he's been doing well overall, no hypos and limited glucose.

Natalie

pgcor
02-05-2009, 12:25 PM
Boy, I'm just not happy with the way this curve is going:

7:45 A - 97
10 A - 49
12 P - 104
2P - 186

Both the Vet and my husband are testing urine too and so far all have been negative, which I would have expected given he's just over the renal threshold now.

I try very hard to keep Pip below the renal threshold and I've been fairly successful until I changed his food amount. I suspect the 4 and 6 readings will be high.

In the past, Pip's nadir was always noon. We dropped his food volume by 15%, I believe last Friday - but could he still be adjusting? I did not mess with the insulin amount and he is still at 6.5 units.

The Vet also said Pip's weight stayed the same!!! I find this hard to believe. His weight is 21.8 and he should be 23 lbs. He looks so much better! Maybe wishful thinking on my part. She claims her scale is accurate - but I wonder? I weighed myself on one of those dog scales that are built into the floor - and I must say - I was at my High School weight again! But, I would hate to have to try on my uniform from those days.

Natalie, I see what you're saying about the curves. At this point, I'm too nervous not to test him... If he would let me do this at home, he'd be a lot better off.

Ugghh, I hate diabetes!!!!!! Love you guys though!

Pam

We Hope
02-05-2009, 01:03 PM
It could be that if you're going to keep the food decrease, there needs to be a bit of an insulin decrease too. Maybe trying to go from 6.5 to 6 units and see if those numbers look better to you.

Of course, we might all have different thoughts once we hear Pip's side of the story later on! ;)

Kathy

pgcor
02-05-2009, 02:14 PM
Pip's last draw was 301!!!! Now the Vet is telling my husband that maybe we should give him his shots at 6AM and 4PM. That's ridiculous. Would you think rebound, given the large increase from 186 to 301? Kathy, maybe a decrease to 6 would help?

I don't know, maybe it's his diet again?????

k9diabetes
02-05-2009, 03:06 PM
A rebound is certainly possible from that 49 this morning. That would be low enough to potentially trigger a release of glucose.

Honestly, I don't think I would base any decisions on this curve - nothing on the high numbers at least. Once it dipped into such low territory this morning, everything that comes after is suspect.

The vet is most likely thinking that the low number this morning and high number this afternoon suggests that the insulin is lasting longer at night than during the day time. I can see the logic of his suggestion given this curve. It is a possibility.

But I still don't think you can depend on this curve for accurate readings after the low occurred.

IF the first blood draw was done as soon as Pip got there, quickly, quietly, no waiting around, minimal stress... then I would put some credence in the fasting of 97. But without a urine test to back it up...

I think your best bet would be to work with Pip at home with urine testing. And you might have him do the fructosamine test just to see what Pip's overall average blood sugar level has been.

Some small diet tweak might help.

It's hard when you're working with a small number of units to adjust insulin in small increments. At 6 units, adding 1 more unit is a 16.6% increase. If a dog was getting 20 units, that would equate to a more than 3 units. Adding one unit to a dog getting 20 units is only a 5% increase.

So -Food Quantity A and 6 units- might match better than -Food Quantity B and 6.5 units- just because the changes don't quite match each other.

Food changes are always tough and take time to sort out.

You won't be able to enjoy Pip, though, if all you do is stress about getting him back to a negative urine test. So don't forget that Pip can live a long healthy happy life even if you never get all his urine tests under the threshold and that the most important thing is to spend some energy letting Pip be Pip and you absorbing all of the joy that brings.

Natalie

pgcor
02-05-2009, 05:10 PM
Hey Natalie!

I'm going to bring Pip back to the Vet tomorrow for a fasting blood check. I'm going to check his urine before we go and see what is what. Hopefully, this is a weird curve and that's it. He ended the day with a 319.

I ran home to meet Don at the Vet. I suggested a chem panel but she did not want to stick him again to draw blood, nor did she think he needed a urinalysis. I'm always outvoted when my husband is there!

I'm going to leave the insulin and food alone for right now and watch Pip for a few days. If I don't get any negative urine tests and he's higher at the end of the day, I thought I might add a tablespoon of brown rice to his food to help the insulin stay longer.

The Vet's step-on scale was wrong. On the baby scale she has he weighed 22.4 lbs. Yeah! Yeah! Yeah! That was my silver cloud!

Thank you Natalie and Kathy for your help!

Pam

We Hope
02-05-2009, 07:03 PM
Pam,

As long as Pip hit that 49 today and then worked his way into the 300's, it sure looks like the counter-regulatory hormones kicked in because of his going low with the 49. They automatically start going into high gear to raise bg's when you're going low. The readings you get for the next 2-3 days may be just as jumbled until the counter-regulatory hormones settle back down again. While I don't believe you'll be seeing anything lower than normal, you may be seeing some higher than normal ones until they get back into normal range.

First of all, Pip had to go to the vet without having eaten, so this would mean he was starting out with lower than usual bg's. It sounds like Pip goes low when he gets stressed, and the no breakfast and stress was why he got down to 49 at one point. Enter the counter-regulatory hormones to raise the bg's.

If this is what's happened, then it's not an insulin duration problem at all and you should see things going back to normal with that within 2-3 days.

You have to give the little guy credit--he's NEVER boring! ;)

Kathy

k9diabetes
02-05-2009, 09:53 PM
Congratulations on the weight gain!! I sure wish I needed to gain a few pounds....

pgcor
02-06-2009, 06:20 AM
I just wanted to post that Pip's urine test this AM was in fact, negative. He went to the vet for a fasting blood draw this morning and he was at 77. I will ask my husband to check his urine today as much as possible so I can see if he does indeed go up at the end of the day.

Kathy, I never heard about counter-regulatory hormones - so I can't thank you enough for sharing that information with me. You must be Doctor!!! However, your explanation does make sense. I will wait awhile and see how things shake out with Pip.

You couldn't be more right - Pip is not a boring dog!!! And Natalie, I wish some of his hyperness would rub off on me. I could sure use a little weight loss! You would think that after all the running after him, through the snow with a pie pan and I would be in great shape! Nah.

Thanks from my heart!!!!

k9diabetes
02-06-2009, 08:56 AM
Wow, that's low. Which does suggest that his insulin injection at night could be lasting more than 12 hours. Did you cut his dose this morning?

I'll be interested to see how the rest of his tests go.

May be that he will need a little less insulin at night in order to avoid going too low in the morning.

pgcor
02-06-2009, 09:38 AM
Hi Natalie:

The Vet advised us to stay at the current 6.5 units. I do think he goes lower when he gets to the Vet. We won't be taking him for a curve today, just the one fasting test.

I was contemplating dropping him to 6 units, but I'm afraid to mess with his food or insulin again. I'm trying to see if he settles into a better routine.

One of the curves we did on him at the Vet started with 27 fasting! We stopped the curve and brought him back home. This particular Vet didn't want us to bring Pip back and forth and asked that we leave him there. I truly believe he couldn't stand the stress of sitting in a cage.

Needless to say that never happened again, and we do not see that Vet any more.

I do welcome your opinion, as I want to do what is best for my Pip. I'm very appreciative of your help!!!

eyelostit
02-07-2009, 01:44 PM
How's Pip today? :)

pgcor
02-08-2009, 05:49 AM
Hi Dolly!! Thanks for checking up on Pip. He seemed to be doing much better for two days. He had negative urine everytime I checked him. Which was quite a bit.

This AM - 700! That's the highest he's been since the food quantity change. I wasn't sure what to do because it could be an aberration or it could be rebound.

I'm going to check him during the day today and if he stays negative then I might reduce his night shot to 6.

I have to admit that I feel a little foolish posting questions after dealing with diabetes for over a year...but...

I don't fully understand the issue with varying insulin dosages in the AM/PM. I know it's done and by quite a few people.

But, if Pip goes low because of stress then logically (at least to me) he would need less in the day and more at night?

I read about diabetes all the time, but it never sticks with me. I just can't remember anything for very long. I saved many of the explanations I received and have a few books, but for some reason....low IQ? LOL

We Hope
02-08-2009, 07:19 AM
Pam,

Needing more or less insulin at a given part of the day is an individual thing--it differs from diabetes patient to diabetes patient using it. Another thing to think about is that most are more active during the day as opposed to night time, so that can also influence a difference in insulin needs. You bet the body turns itself down a notch or two when your usual sleep pattern is, and then we can say that this might make for a case for less insulin needed in the evening.

It can differ with the kind of insulin you're using and how your system handles it also. Lucky used the same number of units morning and evening on pork Lente insulin. When we were just trying to get through pork NPH, he used more insulin overall and a half unit less of that in the evening than during the day.

Now we'll get into a controversial area--that of dawn phenomenon. A bit before we people wake up each day, the system automatically releases cortisol as part of our "wake up" process. People who don't have diabetes don't even notice this is happening because their bodies just release more insulin in response to the temporarily higher cortisol levels and that's the end of it.

But for some with diabetes, this pre-rising cortisol release means they get up with higher than wanted bg's. If someone finds he/she has a dawn phenomenon problem, the answer for it is to increase their evening insulin.

The controversy here is about whether or not dogs have an "organized" cortisol release as humans do, meaning there's supposedly no pattern of when a dog's body releases the hormone. Some studies say they don't, while others say they do, but it's not as pronounced as the cortisol release in humans.

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

The study cited at the wiki page has been moved, but we're able to read an archived copy of it from the Internet Archives here--

http://web.archive.org/web/20060901064414/http://www.vfu.cz/acta-vet/vol72/pdf/72_599.pdf

Just what you wanted this Sunday morning, right--more to think about! :eek:

Kathy

pgcor
02-08-2009, 07:44 AM
Hi Kathy!

Here's where I get confused....if you subscribe to the AM/PM dosage differences, and if activity and stress can lower bg's then wouldn't it seem that more insulin would be needed at night when there's no activity and stress?

Let's pretend that Pip is hyper during the day (LOL) and this activity helps insulin lower his bg. If he needs 6.5 units of insulin to keep him under the renal threshold during the day - wouldn't he need more when he's asleep and not active because he's not helping the insulin lower his bg?

This is how I get lost with reasoning and fact...

We Hope
02-08-2009, 08:40 AM
Pam,

And this is where we get back to the individual--some go higher from stress and some go lower.

http://diabetescontrolforlife.com/articles/monitoring-How-Stress-Affects-Blood-SugarLevels-200093

"Mental or emotional stress has mixed effects, depending on the type of diabetes you have:

"Type 1 diabetes: Mental stress can increase or decrease blood sugar levels."

If we go with the thought that Pip is the type who goes low with stress and that results in more activity, which can also lower bg's, less stress and less activity in the evening could set up a pattern of higher overnight bg's.

Pebbles started having higher mornings for Marianne and her vet didn't believe in the use of R insulin for anything but emergencies, so there was no thought about that. Marianne took her for a morning walk for about 15 minutes, but not in the evening. As an experiment, Marianne added a little evening walk to their routine and that got rid of Pebbles' higher than wanted morning bg's. The added activity reduced her bg's so that they weren't higher in the morning.

What people do when they think it might be the dawn phenomenon that's raising their fasting bg's, they start setting an alarm for about 3 AM to test themselves. If they do this for a few days and the pattern shows that they are higher at that hour (about the time the "wake up" cortisol would be going into the body for "day people"), then they use a little more insulin in the evenings.

A while back, we had someone on the other board who had higher fasting bg's. She set an alarm for a few days for 3 AM and tested her dog, always finding him higher. She slightly increased the evening insulin and that solved the higher morning fasting problem for them.

When you sleep, everything in your body slows down--your heart rate is slower then when you're awake, your breathing rate is less than during waking hours, the body's "demand" for everything is somewhat less. So we have to balance this against a possible insulin increase at night also.

If it's possible to get Pip to do "his bit" at an odd hour, by using the urine test results, we should be able to see where those highs come in. It's also possible that you could "walk away" that higher fasting reading as Marianne did with taking him for a little walk shortly before bed. I think I would first try a little evening walk and see what results you get in the morning after that. If this works, then you could stay right where you are with the insulin just as she did with Pebbles.

Kathy

pgcor
02-08-2009, 09:35 AM
Okay, I get what you're saying Kathy! Thank you a million times. I'm going to try and limit my questioning in consideration of your life!

k9diabetes
02-08-2009, 10:16 AM
As Kathy mentioned, it's not just stress, it's related heavily to activity level, which can have a profound effect on insulin use. When they talk about human diabetics, they mention that exercise can actually raise the blood sugar if the diabetic person doesn't have enough insulin on board to respond to the body's fuel burning. John Walsh in Using Insulin (for human diabetics) devotes an entire chapter to exercise!

Given the pretty low readings you've seen first thing in the morning on blood glucose tests, I think it would be wise to reduce the evening insulin. Starting out the morning with blood glucose readings in the 70s-90s makes me think the risk of hypoglycemia overnight is quite possible. May not happen every night but is likely to happen some nights.

Natalie

pgcor
02-08-2009, 01:04 PM
Yep! I'm going to reduce him to 6 units at night - starting tonight!

Thank you again!!!

pgcor
02-11-2009, 06:03 AM
Back to the Vet with Pip this morning. Now his other eye is closed. Very distressing. He just had a kerototomy (sp?) on his left eye in December. He started scratching his right eye last night. I tried another drop of Tacrolimus and then waited awhile and added the genteal gel drops. No change. I hope this isn't another ulcer. He gets his preventive drops religiously!!!

Luckily he seems to be back to his old "pee" habits. He's been 99% negative. I lowered his evening dose to 6 - and at a teensy, weensy bit over - he gets up negative in the AM now.

I can tell he's tired of all this. As soon as he sees the pie pan he stops peeing. I have sat him down to tell him that life isn't fair sometimes...LOL

Cara's Mom
02-11-2009, 07:36 AM
Hi Pam,
So glad you found this forum! Welcome to you and Pip! Have been following Pip's story from the start and with the help you are getting from Natalie and Kathy, you are doing great! The hardest part are the first several weeks, but thing wil settle down. Cara and I have been there too and we did it!

Best wishes

eyelostit
02-12-2009, 08:47 PM
Okay, I get what you're saying Kathy! Thank you a million times. I'm going to try and limit my questioning in consideration of your life!

LOL:D I needed that laugh tonite !

k9diabetes
02-12-2009, 09:23 PM
Any news on Pip's eye? I hope it's not an ulcer!!

pgcor
02-13-2009, 07:11 AM
Hi Natalie:

Thanks for following up. Very strange...Vet says she can find nothing wrong with Pip's eye - yet he continues to rub with his paw. With two dosages of the tacrolimus (he's ony supposed to get one), he does get better with the scratching.

His urine tests were all positive yesterday - so I switched insulin bottles. See if that works.

Melinda - I know how you feel!!!:eek:

k9diabetes
02-13-2009, 10:05 AM
Maybe it is literally just itchy. Scary that he's rubbing it though - I'd hate to see him cause an ulcer.

pgcor
02-13-2009, 07:15 PM
Hi Natalie!

Pip is doing much better. Not scratching his eye anymore! Had to switch insulin bottles and now he's better in that regard too.

I have to say that I've had nothing but trouble with the insulin from Wal-Mart. It's cheaper, but it's a waste of money for me. We took back two bottles and they gave us two new bottles.

The one I've just discarded wasn't even 3/4 down! I don't know if it's our Wal-Mart or what, but I think I'm just going to opt for the more expensive Humulin N. It's just not worth the aggravation!

Anyone else have problems with Wal-Mart's insulin? Just curious.

Pam

We Hope
02-13-2009, 07:37 PM
Pam,

I know that Novolin N (not ReliOn/Novolin) is made also by Novo Nordisk. I'm wondering if there's a problem at Novo, because basically the only difference in the two insulins is the label, or whether there's a problem at WalMart with the way they handle the insulin they receive.

If the problem is on the WalMart level--somewhere in transit to your store perhaps--there's also a chance the Humulin you buy there might have the same issues.

Novolin (without the ReliOn/Novolin label) is less expensive than Humulin--Novo believes in being very competitive and that's what's made them the #1 insulin producer in the world. The deal to produce the ReliOn/Novolin for WalMart and Sam's Club is part of that.

You might think about going elsewhere to buy a vial of either Humulin or Novolin; if everything's fine with that, then it might be that something's wrong with the way the insulin's handled before it gets to your local WalMart pharmacy.

Kathy

pgcor
02-14-2009, 05:40 AM
Thanks Kathy!!! Wal-Mart doesn't sell Humulin N - I have to go to Walgreens for that. For some reason, I don't have the same issues with the insulin from Walgreens. I'm going to try another Wal-Mart and if the same thing happens, I have to believe it's the way Wal-Mart handles the insulin.

BTW - I roll the insulin, slowly, 20 times before each shot. My husband says that's too much. But, I don't have the same problem with Humulin? I read somewhere that 20 times is the optimal?

We Hope
02-14-2009, 06:58 AM
Pam,

I think it has to do with Wal-Mart and how their insulin's handled before you get it. What we don't know, though, is how far "up" the chain it goes. It may not just be insulin from your local store; the problem could affect all Wal-Marts in the area.

A lot of pharmacies get what they sell from a distributor, who is the "middleman" between your local drug store and the various pharmaceutical companies. If that distributor is not handling the insulins it sells properly, then there could be issues with any of the brands they distribute.

If, for example, a distributor allowed cases of insulins to stay out on a loading dock for a length of time, they could possibly be exposed to heat or cold, depending on weather. If the distributor did this with cases of Novolin and Humulin, they both could be affected by this, though they are made by different companies.

That insulin shouldn't be so fragile that it can't withstand the rolling. Think about the number of people who use insulin pens. They put them in their pockets and purses and that insulin can really get "rolled" a lot as they go about their routine. But you don't hear about this being a problem. It should stand up to being rolled without having potency issues if it left the pharma plant in proper condition and was handled properly before you bought it.

Here's an abstract where they find people using NPH in pens are not re-suspending their insulin enough:

http://87.234.226.93/easd/customfiles/easd/37th/Abs01/92.html

"Although it is well known that NPH insulin should be adequately resuspended prior to s.c. [subcutaneous] injection, patients not always do so especially when using pens.

"The effect of NPH is greater after injection of the cloudy, insulin crystal rich part and may differ up to 2.5 times from injection of the less cloudy, insulin crystal poor, part. These differences may play a role in the day-to-day variability of BG control in T1DM[Type 1--insulin dependent diabetes mellitus]."

It takes a little more rolling to re-suspend Lente insulin because they have the large ultralente crystals as a greater part of the insulin. I noticed that I needed to roll the U 100 Lente more because it was more concentrated than the U 40 Lente. I rolled for about a minute to make sure it was well re-suspended. The only time I had a problem with the insulin was when it came from Lilly at only about 45-50% potency; could keep my Iletin II Lente vial going for close to 3 months before it started losing potency. On Caninsulin/Vetsulin, I could keep it close to 6 weeks and that was when the vial ran out.

You're handling it properly at home, so I think the fault is with how it's handled before it gets to you. ;)

Kathy

pgcor
02-23-2009, 01:12 PM
Hi everyone!

I've been trying to get Pip re-regulated for quite a while now. Close, but not sure if I'm there. We took Pip to the Vet last week to check for an infection and to have a blood panel done. I have to rule those things out.

He's fine according to the results from the Vet. I'll pick them up when I leave work today.

Here's my question:

I finally got Pip back to negative urine before his PM shot at 6:45. He used to be negative in the AM, but sometimes he shows sugar. I'm thinking that I should wait awhile before giving him his insulin shot at night. He's at 6.5 units AM/PM.

If he's negative before the shot, I thought maybe his homemade food wasn't enough to bring his blood sugar up as much as it did on the W/D. That would explain why sometimes he's negative in the AM and sometimes not on the same insulin dose. I even tried lowering a 1/2 unit to make sure it wasn't rebound. I don't think it is. He tested positive for sugar all day, and as often as I could get his urine at night - on 6 units.

Does this sound logical to anyone? I cook for him and he gets chicken, chicken hearts, green beans, zucchini and pumpkin.

Let me reiterate this in case this doesn't make sense. I feed him at night at 6:45 and then give him his shot immediately. If I wait 15 minutes or so after he eats maybe that would help him stay negative until the AM urine?

I hope you can follow this - I don't even know what I'm saying! Old and tired.

Thanks for taking a look at this!!!

We Hope
02-23-2009, 03:13 PM
Pam,

When you do see glucose in Pip's urine tests, are you seeing more than a trace?

If not, that's telling you that while Pip may have gone into above renal threshold overnight, he didn't keep staying on there. If he did, you would be seeing a higher urine test result because as we talked about earlier on this thread, the urine test results are just a "delayed" report of blood glucose ones. If you were testing blood, you would have seen those results hours before. The urine collects in the bladder overnight so what it represents is basically Pip's status since the last time he did what comes naturally. :)

We'll go back to Intervet and urine testing:

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

When you look at Table 3 there, it says that a morning trace with afternoon and evening negatives is acceptable. Look at the results for a trace in the morning and evening, but negative in the afternoon--they indicate that in a dog with those results, there could be a duration (not lasting long enough) problem and it's curve time to see where the problems lie.

Follow on down the table and they show results for 3 times a day negatives--indicates that it's possible there's too much insulin--back to curving to find that out.

You're doing the same thing in the morning with the same amount of food and insulin as you're doing at night--and getting a negative result when you test Pip's urine.

If you start to delay the shot, that could mean that in the food/insulin race, the food will get there first--resulting in high bg's. You normally hold back the shot a bit if you have problems with the insulin "beating" the food and causing lows.

You've discovered that he's not in rebound and can't do well on only 6 units twice a day. Going up with the evening insulin might mean Pip hits a low and that could bring about a "counter" high response.

I believe if you're seeing just a trace of glucose in the mornings, it's not anything to be worried about.

Kathy

pgcor
02-23-2009, 04:42 PM
Hi Kathy:

Thank you for responding so quickly! If Pip were at 100 on the Keto-Diastix, I wouldn't worry. But, he's anywhere between 250 and 500. I think that's more than a trace - correct?

His food has no carb in it, so I thought maybe the insulin was getting to him before the food. He used to get a really big post-prandial rise on W/D.

Before I go to bed at night I make sure he's negative with his urine. So I don't see why he can't stay below the renal threshold all night - like he does all day.

I'm trying to understand all this, but:(

We Hope
02-23-2009, 05:20 PM
Pam,

You're right, your readings are more than a trace. In this case, Pip might be needing slightly more insulin at night than during the day. Pip's normal activities might be helping him keep his bg's down, but when we get to overnight, he doesn't have the benefit of that activity to help him keep his bg's low.

He's eating exactly the same thing mornings and evenings, so I'd have to think that if there was a problem with the insulin and the food match-up, we would be seeing this happen more than just overnight.

Marianne always took Pebbles for a morning walk--and you'd see her bg's going down in response to the exercise. When Pebbles started having higher than normal mornings, as Pip has, Marianne tried taking Pebbles for a little evening walk too. She didn't need to do anything about the insulin or food--the evening walk got the higher than usual fasting bg's down. I don't know if something like this might do the same for Pip or not--might be worth a try to see if it brings his morning bg's down.

Exercise or activity can either raise or lower bg's--depends on the dog, just as it does with people. Since Pip seems to go lower when he needs to be at the vet, I'd suspect that he might be able to lower his fasting bg's the same way Pebbles did.

You've given a try to lowering his insulin to 6 units twice a day and you had nothing but higher bg's all the way, so I'd think that might prove that Pip isn't going low at night and what you see in the morning isn't a rebound response. The only other thing to carefully think about is increasing Pip a half unit at night, but I think I'd try an evening walk and see the results you get first.

Kathy

pgcor
02-24-2009, 06:42 AM
Hi Kathy:

I never thought of exercise. But, you could be right, because he's a couch potato at night.

Thanks a million Kathy - I'll see what I can do about this :)

pgcor
05-10-2009, 02:51 PM
Boy I sure could use some advice....it never fails, as soon as I brag about Pip doing well something always happens.

Typically he gets 6 1/2 units of insulin at 6 AM and 6 units at 6PM. His food is 8 1/4 ozs of chicken, 5 1/2 ozs of green beans, 5 1/2 ozs. of zucchini, 1 oz. of chicken hearts and 2 1/2 ozs. of pumpkin.

He has been doing quite well on this regimen and has been steadily gaining weight since January.

His urine has been showing sugar in the morning for a little over a week now. So, I thought maybe he wasn't getting enough insulin overnight. I raised his insulin 1/2 unit but he was still showing sugar for the next three days.

So, I lowered his insulin to 5 1/2 thinking it might be rebound. He went sky high in the AM after only 1 day. So I put him back on his typical dosages. He's been back on his typical doses since the 8th.

Now he's not sustaining negative sugar all day and is showing 1000 on the glucose strips by 4 - 4:30.

We weighed him today - and while it might not be accurate - it looks as though he might have lost some weight again. But I'm not at all sure. I want my husband to take him to the Vet tomorrow and weigh him.

Do you think a chem panel is warranted as well? I am at a loss :( - nothing has changed with this guy. My husband thought that because it was warmer, maybe he was getting more exercise now and his insulin needs have changed and maybe needs more food?

Your advice would be appreciated!

Pam and Pip

We Hope
05-10-2009, 03:37 PM
Pam,

Don't know where you are with the vial of insulin re: how new it is. I'd suggest trying a new one to see if Pip goes back to normal. If that isn't it, then I think I'd see if he might have a hidden UTI or other type of infection that's raising his bg's. Sometimes all the "warning" you get that there's an infection is the higher bg's. Since Pip's had a bout of pancreatitis, getting a panel done wouldn't probably be a bad idea, as that can show up at first with higher bg's.

Over time, insulin needs can change and go upward or downward for a lot of different reasons. Exercise normally lowers bg's--not sure if Pip goes up or down in response to that. If Pip's one whose bg's go up from exercise, then I'd say that it's more activity because of the good weather.

Know that if it was the heartworm med, that should be over raising bg's by now. He may just need more insulin, but checking everything out if you can gives you peace of mind that it's just a need for more and nothing else.

Kathy

pgcor
05-10-2009, 03:48 PM
Hi Kathy - and thank you for responding so quickly. I just went out last night and got a new bottle of insulin. I was worried about that, but it doesn't appear to be the issue. I think we're going to need a chem panel and a curve. Because I really don't know if his insulin needs are increasing or decreasing. That's what happens without being able to blood test. I know, I know, I sound like a broken record.

Plus, I'm at a loss for the weight loss - if in fact there is one.

Thanks Kathy.

eyelostit
05-10-2009, 10:17 PM
Hi Pam,

I'd get the blood panel done and the curve also, their insulin needs do change at times, I've noticed this with Niki past 2 years.

pgcor
05-11-2009, 01:37 PM
Thanks Dolly! I agree but the Vet is busy today and can't see Pip. My husband took Pip there anyway to see if they could just weigh him. If he's lost weight that would give me a better idea of what is going on. This morning he tested negative on his urine. Without having my paperwork in front of me, I think this is the first time this month.

However, he tested 1000 on the Keto-Diastix at 3 PM. He was negative previous to this time - which seems like rebound? I guess it could be a duration problem - but it doesn't add up to me. He gets 6 units at night and 6.5 in the day.

He started off with a pattern of waking up with sugar in his urine this month. Just recently (past three days), he started showing sugar in his urine at late afternoon.

With all the running around since it warmed up here, I'm wondering if he lost weight and therefore needs less insulin.

My husband thinks he can talk the Vet into just taking a blood sample for a chem test.

At any rate, I think the safest path is to drop his AM dose to 6 until we can get in there to see her and schedule a curve.

However, the Vet told my husband that we should schedule a curve when Pip's bg's straighten out. She claims there's no use in testing an aberration? I get what she's driving at, but how am I supposed to figure out what's wrong with him? Is this is a stupid question?

Did I mention how much I hate diabetes? God forbid I should be redundant.

eyelostit
05-11-2009, 01:52 PM
Thanks Dolly! I agree but the Vet is busy today and can't see Pip. My husband took Pip there anyway to see if they could just weigh him. If he's lost weight that would give me a better idea of what is going on. This morning he tested negative on his urine. Without having my paperwork in front of me, I think this is the first time this month.

However, he tested 1000 on the Keto-Diastix at 3 PM. He was negative previous to this time - which seems like rebound? I guess it could be a duration problem - but it doesn't add up to me. He gets 6 units at night and 6.5 in the day.

He started off with a pattern of waking up with sugar in his urine this month. Just recently (past three days), he started showing sugar in his urine at late afternoon.

With all the running around since it warmed up here, I'm wondering if he lost weight and therefore needs less insulin.

My husband thinks he can talk the Vet into just taking a blood sample for a chem test.

At any rate, I think the safest path is to drop his AM dose to 6 until we can get in there to see her and schedule a curve.

However, the Vet told my husband that we should schedule a curve when Pip's bg's straighten out. She claims there's no use in testing an aberration? I get what she's driving at, but how am I supposed to figure out what's wrong with him? Is this is a stupid question?

Did I mention how much I hate diabetes? God forbid I should be redundant.

Hi Pam,
Is Pip still eating the all homecooked or homecooked and WD, I know with feeding all home cooked at times years ago Niki went into rebound so i had to add some dogfood to her food to get her more matched to the insulin.

Of course here the weather is odd with getting 85 and the following week back to 55, this did affect Niki bg and she went up quite a bit.

What makes up Pip's meal?

Dolly

pgcor
05-11-2009, 02:08 PM
Hi Dolly:

Pip gets 8 1/4 ozs of ground chicken, 5 1/2 ozs of green beans, 5 1/2 ozs. of zucchini, 1 oz. of chicken hearts and 2 1/2 ozs. of pumpkin -TWICE PER DAY He's been finally putting on weight with this mixture and volume. I weigh each item individually for every container of food, so I'm fairly certain we are very close from container to container.

We did weigh Pip at home and on our scale it looks like he lost weight, but I'm skeptical and would rather re-weigh him on the Vet's scale. A pound off on my scale is no big deal, but it is when you're looking at every ounce! I guess I'm not telling you something you don't know!!!!

I can say this...Pip has been jacked up all month. He is an extraordinarily hyper dog - which is why we used to think Cushings. You should see him eat! I wish I had a video camera so I could tape it and play it for folks here. You wouldn't believe it!

From the time I get up in the morning until the bowl is in front of him - he barks - continuously. Once the food is put down he eats like there's no tomorrow. Periodically, he charges my other dog - who at least now, completely ignores him. He's like this no matter if he's in regulation or out, so he's not starving due to high blood sugar.

Don't you think the comment from the Vet about the curve is odd? Or is it me...again?

k9diabetes
05-11-2009, 02:36 PM
However, the Vet told my husband that we should schedule a curve when Pip's bg's straighten out. She claims there's no use in testing an aberration? I get what she's driving at, but how am I supposed to figure out what's wrong with him? Is this is a stupid question?


I don't know that all vets think of curves as a way of sorting out an aberration.... Probably have been trained to view them mainly in terms of adjusting dose.

I definitely would use a curve to determine whether there seems to be rebound or a lack of duration occurring... might need more than one curve. But I see no other way of knowing whether these issues are present.

The one thing that would dictate perhaps WHEN a curve is done would be if you believe that rebound has already occurred. If that's the case, I would drop the insulin dose and give three or four days for things to settle down as far as all of the crazy blood sugar highs and fluctuations that the rebound itself can cause. If you did a curve the day after a true rebound, what you would see would not be the rebound itself but the aftermath of it.

And then however much you reduced the insulin to resolve the rebound might also mean that you'd need a few days on a new, somewhat lower dose of insulin before you could see what that new, slightly lower dose of insulin is doing.

So, to me, it's not IF you do a curve but WHEN.

Natalie

eyelostit
05-11-2009, 03:01 PM
I can't figure why the vet would not want to do a curve.

Just a thought about food I'm wondering if the carb content in the veg's are matching up to the insulin, being green beans, zucchini are very low in carbs,they would take longer to digest also.

If Pip has lost weight that could be why, just a thought :)

pgcor
05-11-2009, 03:59 PM
Hi Dolly and Natalie:

Okay, Pip lost a pound. Urine test at 5:00 when I got home - between 100 and 200. Will be dropping his AM dose by 1/2 unit. This looks like rebound to me.

Pip has been gaining weight on this amount of food Dolly, so that confuses me too. Perhaps with all the running around in the summer, he needs more food?

I've scheduled a curve on Friday for Pip, and a vist to the Institute for the Very, Very Nervous for myself.

Thanks a lot you guys!!!!!

Pam and Pip

eyelostit
05-11-2009, 06:27 PM
Hi Dolly and Natalie:

Okay, Pip lost a pound. Urine test at 5:00 when I got home - between 100 and 200. Will be dropping his AM dose by 1/2 unit. This looks like rebound to me.

Pip has been gaining weight on this amount of food Dolly, so that confuses me too. Perhaps with all the running around in the summer, he needs more food?

I've scheduled a curve on Friday for Pip, and a vist to the Institute for the Very, Very Nervous for myself.

Thanks a lot you guys!!!!!

Pam and Pip

Anytime !!

Found my carb book,

Gr. Beans 1/2 C raw 3.9 carbs 17 calories
Brocolli ''''''''''''''''2.3' carbs 12 cal

Brown Rice cooked 1/2 C 22 carbs 102 calories, this is just an example for you :)

The rice amounts will vary little as to what book or site you are looking at.

Hope this helps, glad you are going in for a curve.

pgcor
05-11-2009, 07:11 PM
I hope you don't mind me asking another question....but I was thinking that maybe I'm scheduling Pip's curve too early.

I have to increase his food as a weight loss of any kind is not good. He's underweight as it is. So, if I drop his insulin and increase his food volume by 10%, that doesn't give Pip but 2 1/2 days before the curve.

I was thinking Tuesday as the Vet doesn't do curves on Monday.

Is that too long?

Thanks a bunch!!!!

We Hope
05-11-2009, 07:30 PM
Pam,

I think a week from tomorrow would be just right because it gives Pip enough time to "settle in" to whatever changes you've made before going for the curve. ;)

Kathy

pgcor
05-11-2009, 08:22 PM
Thanks Kathy!! Dolly, I wasn't ignoring your recommendation for rice in your last post. I forgot to add that Pip's original diet did call for brown rice. I never had good luck with it though and after awhile just removed it. He seem to overeact to that addition.

However, if he continues to lose weight, I will have to try something. I'm loathe to try and add something because I don't blood test at home and it's difficult to get him regulated.

I was going to increase his overall meals by 10%. In other words, add 10% to each ingredient. That would roughly be an once of chicken, and 1/2 ounce of each vegetable and 1/4 ouce of pumpkin additional at each meal. I don't like to raise the organ meat because I'm afraid it will be too hard on his kidneys.

Like I said, he had been gaining on his current diet, so I'm really thrown for a loop with this weight loss. I'm just hoping 10% is enough.:confused:

Again, I so appreciate your advice and help!

Pam

pgcor
05-12-2009, 03:15 PM
Boy, I could just cry right now. I lowered Pip's insulin by 1/2 unit only and only on the AM shot - and he hasn't been negative on urine all day today. Is that an adjustment that might smooth out over a few days or is it too little insulin? His last test showed almost 2000 - he hasn't shown sugar like that since he was first diagnosed.

I think I better keep his curve on Friday. I'm freaking out with this!:eek:

We Hope
05-12-2009, 04:41 PM
Pam,

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

If we take a cue from the information at the link, I agree with you that it should be Friday instead. Getting urine tests positive for glucose morning, afternoon and evening say the dose may be too low--and a curve should be done.

It sounds to me like now it's not enough insulin, because I'd think if we were dealing with a rebound-type situation, doing the slight reduction as you did should still show us Pip's response of getting to a low point (negative urine glucose reading). You were getting negative everything except evening on the previous dose, but now there's no negatives at all.

If you look at the chart for possible rebound situation, they show morning and evening as glucose positive, but afternoon as glucose negative--this would be what I'd expect to see from Pip re: possible rebound.

We'll be waiting to see what Pip's curve results will be!

Kathy

eyelostit
05-12-2009, 08:02 PM
Thanks Kathy!! Dolly, I wasn't ignoring your recommendation for rice in your last post. I forgot to add that Pip's original diet did call for brown rice. I never had good luck with it though and after awhile just removed it. He seem to overeact to that addition.

However, if he continues to lose weight, I will have to try something. I'm loathe to try and add something because I don't blood test at home and it's difficult to get him regulated.

I was going to increase his overall meals by 10%. In other words, add 10% to each ingredient. That would roughly be an once of chicken, and 1/2 ounce of each vegetable and 1/4 ouce of pumpkin additional at each meal. I don't like to raise the organ meat because I'm afraid it will be too hard on his kidneys.

Like I said, he had been gaining on his current diet, so I'm really thrown for a loop with this weight loss. I'm just hoping 10% is enough.:confused:

Again, I so appreciate your advice and help!

Pam

Didn't even think that Pam ;), I know its hard to make any changes as I had a hard time when I was trying to put weight on Niki, not fun, back years ago when dx finding the right diet for Niki was frustrating. I know you'll be glad when you see the curve.

pgcor
05-13-2009, 06:25 AM
You're right Dolly. I can't wait for Friday. He's just not doing well at all.

eyelostit
05-13-2009, 11:06 PM
You're right Dolly. I can't wait for Friday. He's just not doing well at all.

Maybe call the vet and see if they got a cancellation, sometimes they do, with the lousy weather here I think people must be cancelling their appts.:)

pgcor
05-14-2009, 05:59 AM
Hi Dolly - I increased Pip's insulin and he seems to be doing better. I feel I had no choice because the Vet will not do a curve until Friday. She's the only Vet in the practice and always super busy.

So, we're on for Friday. For the life of me, I just don't understand why he goes out of regulation like this. It happens so fast and for no apparent reason that I can think of. I had hoped it was the heartworm treatment.

Only one more day like this...

eyelostit
05-14-2009, 05:29 PM
Pam,:)
I was LOL at your post for another member as you mentioned trying to get Pip's blood and it was like you cut off a leg.

pgcor
05-15-2009, 06:24 AM
Pip had his first blood draw this morning. His urine tested at 1000 this AM and his bg was 67 and on another meter it was 83.

Here's what I find odd....the Vet wants my husband to take Pip home, feed him and give him NO insulin. Bring him back at 10AM to check his blood.

It seems as though he's getting too much insulin, but how will we know how to adjust his insulin if she doesn't want us to give him any?

This is very confusing to me...

pgcor
05-15-2009, 08:19 AM
Pip's second blood draw was at 10AM and was 147 - still she wants us not to give him insulin.

According to my husband between the 8 and 10 AM blood draw Pip pooped on the floor - and pardon the description - but it was watery, bloody and loose stool.

He took a sample with him and she will have results at noon. I think I better leave work and see what's going on for myself.

This is too nerve-wracking to me.

Keep your fingers crossed!

Patty
05-15-2009, 03:07 PM
Pam,
How did the rest of the day go?
Patty

pgcor
05-15-2009, 04:39 PM
Oh, thanks for checking on us Patty! First time I've had a chance to sit down and type this...

8AM - fasting- 67
10A - ate his regular food, but no insulin - 147
12P - 327 - brought him home and gave him 3 units of insulin
2P - 299
4P - 262
6P - 253
Fed regular amount of food and gave 3 more units of insulin.

The vet checked Pip's stool and found bacteria. It doesn't say what type of his paperwork, but it was something that began with cox... She said it could be stress related but that it didn't appear to her that it was. In other words, she doesn't know.

She said if his next bowel movement is runny (sorry!) we'll have to put him on an antibiotic.

She was surprised by the weight loss as well since he had gained weight on this volume. But we have bumped up his food by 10%.

I am so glad this day is over. Between Pip and calls from work....

I really would welcome your thoughts. I would think this is a curve that won't tell much? It certainly is no typical day.

I did however, agree with her recommendation to drop him to 6 units of insulin in the AM and 5 1/2 at night - after today.

Thank you everyone!

Pam and Pip

k9diabetes
05-15-2009, 10:57 PM
FROM May 11

However, he tested 1000 on the Keto-Diastix at 3 PM. He was negative previous to this time - which seems like rebound? I guess it could be a duration problem - but it doesn't add up to me. He gets 6 units at night and 6.5 in the day.

He started off with a pattern of waking up with sugar in his urine this month. Just recently (past three days), he started showing sugar in his urine at late afternoon.

The interesting thing about this to me is that 3 units of insulin kept his blood sugar level through the afternoon...

Probably most of his food was already digested and passed through the bloodstream showing up as the 327 two hours after eating. So I'm thinking that the curve numbers in the afternoon reflect, more or less, his basal insulin needs and that 3 units did a pretty good job of holding that steady and even dropping it slightly.

That's half his usual dose so sounds about right for basal needs.

I wonder if the sugar showing up in his urine is from the insulin moving more slowly than his meals. That you've got most or all of his food being digested in two to three hours, before his insulin really has a chance to get up to full speed.

So that would dump glucose into the urine, which you're picking up in the morning. And then late in the morning, when the food is long gone, there's still some insulin fairly strongly in play, resulting in the low blood sugar first thing.

Could also be that this is happening much more at night than in the morning due to the difference in activity level.

A drop in dose is definitely called for at night as that low was awfully low... though vet stress may be dropping it more than at home. Maybe at home he's not going nearly that low, which is why you're seeing the 1,000 on the urine strips.

When you have a dog who stresses big time at the vet and who can't have blood glucose checked at home, that's the time I'd add a fructosamine test... to see how his control looks from high orbit for the past couple of weeks.

My guess is that the cause of sugar in his urine may be an issue of food/insulin imbalance.

Have you ever given any Regular insulin?

That might be the way to balance things out with Pip. You would cut the NPH, perhaps to 3 units, and then give a small amount of Regular... maybe start with one unit.

The Regular would get moving much faster and potentially balance better with the food and then let the NPH handle the basal need the rest of the day.

Might talk it over with the vet and see what she thinks.

Natalie

pgcor
05-16-2009, 05:52 AM
Thank you Natalie for reading my post. No, regular insulin has never come up, but I will talk to the Vet about it. I'm afraid that I've had many, many vet issues and after 5 vet, finally settled on the "least wrong" out of all of them.

I have to ask you something else - I hope you don't mind - but this is definitely for my educational purposes!!!! I'm trying to get my thoughts together so bear with me...

Would a combination of regular and NPH be equivalent to adding a carbohydrate to his diet and leaving him on NPH?

Since he's prone to pancreatitis, and has a fairly strong reaction to carbs, would that be a reason to combine the insulins?

It looks as though he's having more bowel problems this AM, so he may have to go on an antibiotic. If he does, would you think I should wait until he's off the antibiotics before combining insulin? I would think so, but frequently, I'm wrong!

Thanks Natalie!

We Hope
05-16-2009, 07:56 AM
Pam,

I'd not change anything with the insulin for Pip until you get the question about his possibly needing antibiotics settled. If you've read through some other threads here, you've see people whose dogs have had infections which has sent their bg's through the roof. Those bg's settled back down to normal levels once the infection was being treated.

We discovered a way to check Lucky's bg's via the whites of his eyes. While it doesn't give you a precise reading, it lets you know whether or not you're in a good range.

Back when we were dealing with constant high bg's, I noticed that the whites of Lucky's eyes would become an angry red. John and I talked about it and we started doing an "eye check" before testing Lucky. Every time we would see this, the test would show that Lucky was high.

When we got him controlled on the old Lily pork, he went to a low and we discovered that the eyes were once again red, but the shade of this red was of a darker color.

In each case, the whites would return to normal (no red) once you'd solved the problem--high or low. If I saw that Lucky had no red showing in the eyes, I'd tell John that I thought we'd be happy with the test results. Lucky's eyes told us what the "score" was every time.

John decided to see if this only applied to Lucky, so he began taking a look at the eyes of all his diabetes patients before testing, etc. Their eyes also told John before the test did as to whether they were high, low, or in normal range.

I think you could learn how to work this out with Pip and it would be another way of checking on him.

Kathy

k9diabetes
05-16-2009, 10:04 AM
Would a combination of regular and NPH be equivalent to adding a carbohydrate to his diet and leaving him on NPH?

Since he's prone to pancreatitis, and has a fairly strong reaction to carbs, would that be a reason to combine the insulins?



Usually carbs are digested quickly and NPH has trouble moving fast enough to keep up with their digestion. So the situation that you "might" have with Pip now - I'm not certain that's the case of course - would be equivalent to too many carbs.

If NPH lasts barely 12 hours, the body is essentially out of it by the next meal and injection. And that next injection doesn't take effect instantaneously. It can take a while before you get a significant effect from the insulin.

So you can have a situation in the first hour or two where there's no insulin at all left from the last injection and the new injection hasn't really kicked in yet. Meanwhile, the carbs are being digested at light speed and being dumped into the bloodstream, sending the blood sugar soaring during the first couple of hours.

The other thing that happens in this scenario is that when the NPH does finally get going strongly there's no food left for it to work on. So it can sharply drop the blood sugar later.

Regular gets moving a lot faster typically than NPH. So you can give a little Regular to get insulin in the blood along with those speedracer carbs. They would be better matched, evening out everything for that period.

____________

I agree not to change things while doing the antibiotic.

Looking down the road, though, another curve under more normal circumstances could help flesh out his insulin/food balance.

But I worry that vet stress is influencing his curves and in the end if his regulation is not good, you might want to consider experimenting with some changes in tiny increments and watch how that influences his urine tests, etc. The ability to test him is limited to in the end some gentle experiments and observation of the results could be a way to determine what works and what doesn't.

With history of digestive problems, etc., I don't like to do food changes if not absolutely necessary.

Plus I think it's hard to experiment with food with a dog you can't curve.

So I'd try the insulin change first (IF you do any of this). You would see an immediate response. Within a day or two you would know if things seemed better balanced and Regular's effect on blood sugar levels would be more predictable than a food change.

Hope the antibiotic improves some things! :)

Natalie

Patty
05-16-2009, 10:42 AM
Hoping the antibiotic clears things up Pam and you can get back to sorting out food/insulin match!
Patty

eyelostit
05-16-2009, 10:54 AM
Pam,

Looks like you've been thru the wringer last few days, I hope things even out. :)

pgcor
05-16-2009, 12:41 PM
Thank you everyone for your concern. I'm trying not to be too down, but our Vet is really not very good. I have to "suggest" things to her. She doesn't look for patterns, she just takes the blood.

Pip has been laying around all day, and his urine tests have never been under 500. He's up in the 1000 and 2000 all day. I'm worried and I'm mad. I don't feel I adequately take care of him. I just throw money at it.

k9diabetes
05-16-2009, 05:24 PM
Pam,

Chris may have been the most well-behaved diabetic dog in the world but you should meet my cats... any medical care beyond one injection of a vaccine (and if they take too long, that door will close too!) requires anesthesia!!

So if we are not willing to put Gus under every time we want to know how is IBD/Lymphoma is doing... tough. So we treat him to the degree that he allows us to treat him, we cross our fingers, and we hope for the best.

With him it's a HUGE accomplishment that I found a way to get his little itty bitty prednisolone and leukeran pills into him. If he ever starts rejecting the salmon cream cheese or if he needs bigger pills, we won't be able to treat him at all.

That's the way it is. Nothing I can do about it.

Similarly, if there's ever a fire in our house, I know we will lose Katie. Because the first thing she does (she's feline) is hide in the garage. At the sound of a doorbell, let alone a smoke alarm. I will not be able to get her out. Either she comes out on her own or we will lose her.

Nothing I can do about that either.

So you do what you can do with Pip and know that you are doing the best that anyone can do.

I am acquainted with a diabetic dachsund who was pretty much just like Pip. Urine testing and fructosamines were the only way to monitor his blood sugar. So be it.

As far as suggesting things, we can help you work this stuff out and try some simple, very gentle experiments to see what effect they have.

Also, please remember, that if this is the best regulation Pip ever gets, it's okay. That sounds contradictory maybe... I don't buy the argument that because a diabetic dog can live a long good life with less than perfect regulation we shouldn't try to perfect regulation. I mean really... why wouldn't we try?!?!?! But I also KNOW that a dog can have a long happy life without perfect regulation and the last thing you want to do in those precious years is spend all of your time worrying about why you can't get it better. Do what you can and then enjoy Pip and don't let futzing with his regulation become a career or an obsession. Let it go and live life with Pip.

Natalie

eyelostit
05-17-2009, 12:29 AM
I don't feel I adequately take care of him. I just throw money at it.

You are taking good care of Pip Pam, don't be so hard on yourself.

With Niki at dx she was really sick, did she act sick ? No.. even tho she had ketones, panting etc. per the vet. Did I know anything about diabetes at the time? No... I felt helpless, I didn't trust the vet anymore. We didn't find the boards until 9 mo later, , didn't know anything about testing etc. so now we are over a year into diabetes and we are still trying to figure this all out. It just took me time Pam, that's all I could do, Niki was not a dog who was going to be at the so called perfect bg figures.

After finding the boards it took me a long time to figure out what worked for Niki, she wasn't regulated. I started home testing and worked with a lot of different diets, then I had to step back and take a break it was making me a wreck. Of course Niki looked at me like I was nuts. Forward 6 yrs and Niki is doing fine.

I know how you feel. Whatever you do Pam, I know you are doing your best.

Chin up kid ;)
Dolly

pgcor
05-17-2009, 05:54 AM
Thank you Natalie and Dolly. I'm just reading over my posts and feeling bad that I sound so crazy. Sorry. I'm a terrible worrier and since I have complete control over Pip's life, I feel responsible for everything that goes wrong.

I decided not to lower Pip's PM injection to 5 1/2 and gave him 6. He woke up this morning with urine between 100 and 200. Way, way better.

Today is a new day:)

Patty
05-17-2009, 10:38 AM
Yea Pam! Hang in there...

eyelostit
05-17-2009, 11:42 PM
Thank you Natalie and Dolly. I'm just reading over my posts and feeling bad that I sound so crazy.


Nope you didn't sound crazy to me ;), I can just imagine what I had posted years ago, sometime if I can I will have to look one of my old posts up.;)

pgcor
05-18-2009, 05:07 PM
Well, Pip is better but still not doing great. We're going to give it two more days to see if he evens out. If not we'll bring him back to the Vet to run a fructosamine test and a CHEM PANEL....that my husband told her not to run again...

He did not do well at all by dropping the insulin. Natalie, I printed off your message about the regular insulin. I'll bring it with me to see what she says.

Thanks a lot everyone for your help and support.

eyelostit
05-19-2009, 07:46 PM
Well, Pip is better but still not doing great. We're going to give it two more days to see if he evens out. If not we'll bring him back to the Vet to run a fructosamine test and a CHEM PANEL....that my husband told her not to run again...

He did not do well at all by dropping the insulin. Natalie, I printed off your message about the regular insulin. I'll bring it with me to see what she says.

Thanks a lot everyone for your help and support.

Anytime :) we'll be anxious to hear about the vet and tests

pgcor
06-18-2009, 02:16 PM
I've been having a real "time" trying to get Pip's food and insulin matched since the last time I posted.

Recently I increased his food by 10% again because he continues to gradually lose weight. I also increased his insulin 1/2 unit. That's all I feel comfortable doing because I can't blood test him.

He seemed to be doing okay and I thought he might even out. By okay I mean he had a few negatives throughout the day. But now he's dramatically increased his "sugar output". It's been 1000 to 2000 every day, only going to 500 at its lowest.

I'm taking him to the Vet tonight when I get home, but I'm wondering about something.

Do you think it's possible he was doing "okay" for a while but then after eating the increased food volume he gained weight and now he's really showing so much sugar?

My Vet is not very good but she tries to help....as some of you know she's the fifth Vet we've seen.

I'll be bringing in a urine sample with me and I'm going to demand a chem. panel. Last month my husband brought him in and she told him we didn't need to do one. That's all my husband needs to hear as he's more worried about the cash output.

I've seriously thought about uploading a video of Pip at dinner time so you can see how horribly hyper he is. I'm wondering if he doesn't have other health "issues". He is so hyper that sometimes I have to lock him out of the room in order to hear myself think.....

I've never seen a dog this hyper before - surely there must be a reason for it?

Pam

Dakotapix
06-18-2009, 02:31 PM
I had the same question for my vet four weeks ago after she had asked us to increase my dog's food intake by 50 percent. I asked if the new diet was affecting his high bg readings and she said it was not the cause. He has now regained two pounds (from 17 1/2 to 19 1/2) over the course of about six weeks and wants me to continue with that diet.

I've been having a real "time" trying to get Pip's food and insulin matched since the last time I posted.

Recently I increased his food by 10% again because he continues to gradually lose weight. I also increased his insulin 1/2 unit. That's all I feel comfortable doing because I can't blood test him.

He seemed to be doing okay and I thought he might even out. By okay I mean he had a few negatives throughout the day. But now he's dramatically increased his "sugar output". It's been 1000 to 2000 every day, only going to 500 at its lowest.
Pam

eyelostit
06-18-2009, 04:31 PM
I've been having a real "time" trying to get Pip's food and insulin matched since the last time I posted.

Recently I increased his food by 10% again because he continues to gradually lose weight. I also increased his insulin 1/2 unit. That's all I feel comfortable doing because I can't blood test him.

He seemed to be doing okay and I thought he might even out. By okay I mean he had a few negatives throughout the day. But now he's dramatically increased his "sugar output". It's been 1000 to 2000 every day, only going to 500 at its lowest.

I'm taking him to the Vet tonight when I get home, but I'm wondering about something.

Do you think it's possible he was doing "okay" for a while but then after eating the increased food volume he gained weight and now he's really showing so much sugar?

My Vet is not very good but she tries to help....as some of you know she's the fifth Vet we've seen.

I'll be bringing in a urine sample with me and I'm going to demand a chem. panel. Last month my husband brought him in and she told him we didn't need to do one. That's all my husband needs to hear as he's more worried about the cash output.

I've seriously thought about uploading a video of Pip at dinner time so you can see how horribly hyper he is. I'm wondering if he doesn't have other health "issues". He is so hyper that sometimes I have to lock him out of the room in order to hear myself think.....

I've never seen a dog this hyper before - surely there must be a reason for it?

Pam

Hi Pam,

Pip has gained some weight, with more food and 1/2 increase in insulin is that right? and now he is showing high on the urine strips, still using the food increase and 1/2 unit more insulin.
I don't know about Pip's breed but some breeds are more anxious than others.

Anxious to know what the vet says

Dolly

We Hope
06-18-2009, 06:27 PM
Pam,

When Lucky's diabetic cataracts spontaneously dissolved, he was having terrible panic attacks; the sudden clearing of his vision frightened him at first. When he would have one of these, I had to hold onto him because he was constantly running and trying to crawl under places which were too small and he could have been hurt there. Am not kidding when I say I had to hold him on my lap to use the bathroom.

We were using some Valium, some Rescue Remedy and some Five Flower Formula drops. As he got used to being able to see clearly again, the Valium went to as needed, we no longer needed the Rescue Remedy, but stayed with a drop of Five Flower Formula in his water each time it was changed (twice a day).

Toodles (non diabetic) can get into states of frenzy at times, but he was abused and has a seizure disorder. He takes a small amount of phenobarbital twice a day; since we discovered the seizure problem and started treating it, he doesn't get as worked up as he used to. I couldn't lock him out of a room, because he would immediately start barking and carrying on constantly.

He had such a bad case of separation anxiety, I couldn't take the trash out without him starting up. Whenever I needed to go anywhere he couldn't, I'd need to drop him at the hospital while I did what I needed to do, so he wouldn't sit at home and constantly carry on. It was easy to hear Toodles outside with all the windows closed. :eek:

Since treating his absence seizures, I can go out without him for reasonable periods of time and there's no commotion anymore.

Kathy

pgcor
06-18-2009, 06:40 PM
I guess we'll see what's what on Saturday. The Vet took $331 worth of tests. She measured his blood sugar and it was 103. I gave him 1/2 unit additional at dinner time at 5:10. I gave him his shot and dinner 1/2 hour early because his urine tested so high. The 103 was at about 7, so that's about two hours later.

He has gained a pound and is now at 22.7. She believes his ideal weight is 24 lbs. but realizes we may never get there. I think 23 is the highest he's been since he lost all his weight at the diabetes diagnosis.

He does look a lot better. What's the first thing he does when he gets home? - pees all over my table in the living room. He's lucky we love him....

forloveofandy
06-18-2009, 08:40 PM
Sorry Pam I had to laugh about peeing on the table! I can relate.

I sure hope the tests come back with good news. Do you buy those urine test strips that have all the different parameters on them? Carla told me where I could get them for cheap. I buy them for testing between times and for my other dogs. Saves me a little money.

http://hocks.com/hocks-healthcare/hocks-product/URS-10.html

forloveofandy
06-18-2009, 08:43 PM
Pam I have a little female doxie that is OCD and so hyper she drives me nuts. She has been on doggie prozac for months. It barely does anything for her.

Nothing wrong with her, she is just an anxious dog. Good thing we love her too!

pgcor
06-19-2009, 06:03 AM
Hi Anne - Thanks for the info. I do have the urine chem strips from Hocks, but as I understand it - and maybe someone knows this for sure - for some infections only a culture will be definitive. At any rate, that strip didn't show anything abnormal.

k9diabetes
06-19-2009, 11:29 AM
Given that he's gained weight and had a 103 BG at the vet, I think you have to consider rebound as the cause for the very high urine tests.

The urine multitest strips can sometimes hint at a UTI but it's not guaranteed. If they don't show anything going on, that wouldn't rule one out. So glad you're having it checked.

Thyroid is one hormone that can really affect their behavior, even causing aggression if it's too low.

Do you see changes in Pip's behavior recently or is this just how he's always been, such as with the food, but because you're worried about him it's bothering you more?

I forget what med our vet suggested might be used for Jack to help him overcome some of his anxieties. Prozac was one suggested but there was another and I can't recall the name. We haven't gone there yet - are working very hard with training and seeing some progress.

Originally Jack ate so fast that we had to do the ball in the dish thing to make him eat around it. But he's relaxed some on that issue.

I hope the tests will help you get to the bottom of things. It's always hard... I'm happy as heck when the tests show nothing amiss but then I'm still left wondering what's causing the problem! We went through that many times with Chris.

Natalie

pgcor
06-20-2009, 03:00 PM
I just received all of Pip's tests. They are all normal. His test for pancreatitis was 77, whichis normal. The lab results say anything uder 200 ug/L is normal.

His fructosamine test was 347 umo/Lwhich is in the normal range. and is considered excellent control. But, given the highs and lows, who knows?

The only values that showed a little high were something called MCHC. The reference range was 32 - 36 and Pip was 36.2. LIPA was a little high at 866 (reference range was 100 - 750), BUN/UREA was 41 and the reference range was 7-27 and finally the B/C Ratio which was 58.6 with no reference range.

He seems to come down to the negatives now with 7 units in the AM and PM, but by 3:00 he tests at 500 - 1000 on the urine strips.

Natalie the 7 units in the day haven't changed - I just added 1/2 unit at night. I hate to go backwards because he seem to be doing okay at 6 1/2 and 7.

The Vet just said his tests were "beautiful" and don't worry about the high sugar.

He's excessively "ferocious" lately - charging our other dog, especially when it's time to eat, but he's also been peeing in his diaper, which I'm inclined to believe must be marking? He does that all the time, which is why he has to wear the male wrap, but lately his wrap is always wet when I check. The cultures will be back next week...

Do you think the elevated BUN/CREA level might be something? The Vet didn't think anything of it...but we didn't talk with her. The receptionist said the Doc told her to tell us his tests were beautiful.

Whenever he does go out of whack, this seems to be the pattern.

Pam

forloveofandy
06-20-2009, 07:41 PM
Pam do you separate them to eat? I have four and they all go into separate rooms. Each one knows which room to go to and they all run into the appropriate room when the bowls are ready.

Sammy is aggressive at times to Andy. Sammy also is one to go outside and mark territory when we are on a walk. Andy does not. I think maybe it is just a dominance, pack leader situation with them and wonder if that might be it with your Pip?

The marking is really something isn't it? We had a foster for a while that marked everything in site, including everything in the house. That is one thing very difficult to deal with once they establish it.

Good news on his tests. Nothing really bad to report.

The doggie downer that Roxy is on is Clomipramine. Without it, Roxy would not have much quality of life. As she truly is OCD. She will begin licking the floor on one side of the room and lick all the way to the other side. She also bounces off the walls without it.

It does not sound like Pip is that extreme but medication along with training can be effective too. Then at some point wean them off the medication.

eyelostit
06-21-2009, 03:23 AM
I just received all of Pip's tests. They are all normal. His test for pancreatitis was 77, whichis normal. The lab results say anything uder 200 ug/L is normal.

His fructosamine test was 347 umo/Lwhich is in the normal range. and is considered excellent control. But, given the highs and lows, who knows?

The only values that showed a little high were something called MCHC. The reference range was 32 - 36 and Pip was 36.2. LIPA was a little high at 866 (reference range was 100 - 750), BUN/UREA was 41 and the reference range was 7-27 and finally the B/C Ratio which was 58.6 with no reference range.

He seems to come down to the negatives now with 7 units in the AM and PM, but by 3:00 he tests at 500 - 1000 on the urine strips.

Natalie the 7 units in the day haven't changed - I just added 1/2 unit at night. I hate to go backwards because he seem to be doing okay at 6 1/2 and 7.

The Vet just said his tests were "beautiful" and don't worry about the high sugar.

He's excessively "ferocious" lately - charging our other dog, especially when it's time to eat, but he's also been peeing in his diaper, which I'm inclined to believe must be marking? He does that all the time, which is why he has to wear the male wrap, but lately his wrap is always wet when I check. The cultures will be back next week...

Do you think the elevated BUN/CREA level might be something? The Vet didn't think anything of it...but we didn't talk with her. The receptionist said the Doc told her to tell us his tests were beautiful.

Whenever he does go out of whack, this seems to be the pattern.

Pam

Hi Pam,

I am waiting on Niki's blood results also, I worry more than I did in the past and probably should not (easier said than done) anyway this page will help you out regarding the bloodtests, Kathy put a lot of links there, I know I will be looking at them come next week, hope this helps.:)
http://k9diabetes.com/forum/showthread.php?t=842

Dolly

pgcor
06-21-2009, 05:27 AM
OMG - thanks Dolly - I never saw that area regarding tests. I'll bet it's been discussed a million times though! I think Pip may be getting slightly too much protein in his food. I'll have to talk with the Vet.

eyelostit
06-21-2009, 02:35 PM
OMG - thanks Dolly - I never saw that area regarding tests. I'll bet it's been discussed a million times though! I think Pip may be getting slightly too much protein in his food. I'll have to talk with the Vet.

Yep, when I get Niki's tests back, I'll be calling the vet too !;)

pgcor
06-27-2009, 07:46 AM
Hi All! I'm hoping someone can give me an opinion, based on urine tests alone. Pip is scheduled for a curve on Wednesday the first. But, I'm concerned about him as he's been high on his urine tests and peeing (rather than marking) in his wrap.

I know it's hard without blood work, but I'm worried about him.

His food volume has not changed. On 6/17 he was still getting 7 units in the Am and 6 1/2 at night - same as he's gotten for several months now. We increased his food volume on 6/8 by 10% and he started to go out of whack then. On 6/18 I started giving him 7 units in the AM and PM. We started inching over 7 units by 6/20 and since 6/23 he's gotten 7 1/2 units in the AM and PM.

Does it look to you like rebound? I took these to the Vet and she doesn't know. This AM he was about 300 at first urine and is now at 1000.

6/17: 5:30A 500
10A 700
12:30 - 400
5P - 100

6/18 - 5:30 2000
9A 1000
12 500
3P 1000
9P - Negative

6/19 5:30 A - Negative
10A Negative
3 P - 700

6/20 - 5:30 1000
10:30 Negative
3:30 P - 1000

6/21 5:30 A - 500
10:30 - 500
2:30 - 500
5P - 500
9:30P - Negative

6/23 - 5:30 A - 1000
9A - 700
12 - 700
3:30 - 1000
8:30 - 400

6/24 - 5:30 - 800
10:30 Negative
1:30 - 700
4P - 700
7:15 - 1000
8:30 P - 400

6/25 5:30 - 500
9A 1000
11A 300
1:30 P 2000
4:30 P 1000
730 P 1000
9P - 300

6/26- 5:30 - 100
9A - 50
Noon Negative
3 - 600
4:30P 1000

pgcor
06-27-2009, 07:49 AM
I forgot to add that all Pip's bloodwork were fine and his urinalysis and culture were fine as well. She asked me to check his teeth and ears and I don't see or smell anything wrong....

eyelostit
06-28-2009, 08:18 PM
Hi All! I'm hoping someone can give me an opinion, based on urine tests alone. Pip is scheduled for a curve on Wednesday the first. But, I'm concerned about him as he's been high on his urine tests and peeing (rather than marking) in his wrap.

I know it's hard without blood work, but I'm worried about him.

His food volume has not changed. On 6/17 he was still getting 7 units in the Am and 6 1/2 at night - same as he's gotten for several months now. We increased his food volume on 6/8 by 10% and he started to go out of whack then. On 6/18 I started giving him 7 units in the AM and PM. We started inching over 7 units by 6/20 and since 6/23 he's gotten 7 1/2 units in the AM and PM.

Does it look to you like rebound? I took these to the Vet and she doesn't know. This AM he was about 300 at first urine and is now at 1000.

6/17: 5:30A 500 7 units am 6 1/2 pm
10A 700
12:30 - 400
5P - 100

6/18 - 5:30 2000 7 units am and pm
9A 1000
12 500
3P 1000
9P - Negative

6/19 5:30 A - Negative
10A Negative
3 P - 700

6/20 - 5:30 1000 starting inching over 7 units
10:30 Negative
3:30 P - 1000

6/21 5:30 A - 500 7 1/2 units am and pm
10:30 - 500
2:30 - 500
5P - 500
9:30P - Negative

6/23 - 5:30 A - 1000
9A - 700
12 - 700
3:30 - 1000
8:30 - 400

6/24 - 5:30 - 800
10:30 Negative
1:30 - 700
4P - 700
7:15 - 1000
8:30 P - 400

6/25 5:30 - 500
9A 1000
11A 300
1:30 P 2000
4:30 P 1000
730 P 1000
9P - 300

6/26- 5:30 - 100
9A - 50
Noon Negative
3 - 600
4:30P 1000

Hi Pam,

Its hard for me to tell with the urine readings but with the 50 on 6/26 Friday looks like Pip stayed in the negative range from 9:00 am till about 2:00 pm, seeing the 2000 on the 25th I wouldn't expect to see, are these readings am and pm fast first urine sample or does Pip pee first then you take urine from 2nd sample.

Could possibly be some rebound going on but I can't really tell, I'll be glad to see Pips curve, I know you will too ;)

Dolly

pgcor
06-29-2009, 07:48 AM
Thanks Dolly!!!!! I figured it would be too hard to tell. It's so frustrating. Glad to hear that Nikki is doing well!!!

Pam

k9diabetes
06-29-2009, 01:16 PM
http://i37.tinypic.com/34hdmqr.jpg

6/17: 5:30A 500
10A 700
12:30 - 400
5P - 100

The above seems pretty stable

6/18 - 5:30 2000
9A 1000
12 500
3P 1000
9P - Negative

Negative was a big drop here...

6/19 5:30 A - Negative
10A Negative
3 P - 700

6/20 - 5:30 1000
10:30 Negative
3:30 P - 1000

Big difference here too

6/21 5:30 A - 500
10:30 - 500
2:30 - 500
5P - 500
9:30P - Negative

Stable.

6/23 - 5:30 A - 1000
9A - 700
12 - 700
3:30 - 1000
8:30 - 400

Fairly stable

6/24 - 5:30 - 800
10:30 Negative
1:30 - 700
4P - 700
7:15 - 1000
8:30 P - 400

6/25 5:30 - 500
9A 1000
11A 300
1:30 P 2000
4:30 P 1000
730 P 1000
9P - 300

These two suggest to me that the insulin is dropping the BG well in the morning.

6/26- 5:30 - 100
9A - 50
Noon Negative
3 - 600
4:30P 1000
Most days I don't see rebound as a likely possibility as you don't have a huge rush of high BG after negatives or very lows. The 20th and the 25th are days where I'd say rebound is a possibility. I'll be anxious to see what the curve looks like.
Nataliehttp://www.k9diabetes.com/forum/images/misc/progress.gif

pgcor
06-30-2009, 01:19 PM
Thanks Natalie. I'll be glad to get this curve over with tomorrow. I'll keep you posted.

Pam

pgcor
07-01-2009, 02:18 PM
Well, I THINK I might know what's been wrong with Pip. I think it takes him at least a week possibly two to adjust to new food - AND - he needs to get less insulin at night. His curve today has been going quite well. This morning's urine was 2000, which had me worried, but the blood results are vastly different - leads me to believe I need to lower his insulin at night again. Kathy, do you remember telling me to do that the last curve? I should have waited longer, but panicked when I saw all the sugar...

8 AM - 160 (fasting)
Food and 7 1/2 units of insulin around 9 AM
10 AM- 112
Noon - 72
2 PM - 116
4 PM - 128

He was getting 6 1/2 and 7 and then we adjusted his food. We raised him to 7 and 7 1/2. I don't think I waited long enough for him to settle in before raising his evening does to 7 1/2.

The urine of 2000 seems like it may have been rebound so will lower him back to 7 units. What do you think?

He has one more draw but I would be surprised if he went over the renal threshhold. Typically he gets his shots at 5:45 AM and PM...

I am so relieved after this curve. To me the curve looks good.

As God is my witness I hope to never tweak food again.

Pam

pgcor
07-01-2009, 04:26 PM
I guess I better get used to being wrong. His last draw was 226 at 6PM. That's over the renal threshhold and not even 12 hours since his shot in the AM at 8:15.

Why would he jump almost 100 points from 4 to 6?

8 AM - 160 (fasting)
Food and 7 1/2 units of insulin around 9 AM
10 AM- 112
Noon - 72
2 PM - 116
4 PM - 128
6 PM - 226

The insulin does not appear to be lasting and it doesn't appear he's burning it up quickly?

Any thoughts? Now I come home at 5, could his extreme excitement at seeing me (LOL) cause that?

This is why we went to 7 1/2 units at night because his urine showed sugar before his next shot...:confused:

k9diabetes
07-01-2009, 05:44 PM
Just have a second Pam... that last reading is over the threshold but not by much and it must come down at night because it was only 160 this morning. I'm more concerned about the 72 than the 226 - with a little bit of wobble that could be too low.

Overall, I think it's a beautiful curve.

Will get back later...

Natalie

pgcor
07-01-2009, 07:09 PM
Hi Natalie:

I think something must be wrong, because 226 was his reading only after 10 hours. My fear was that he went up 100 points between 4 and 6, and in another two hours he could go up another hundred points, putting him in the 300 range by 12 hours.

You're right about the 72 - I can't give him more insulin because the 72 could go lower.

I gave him 1/2 unit lower this evening because of the 2000 reading on the urine and 160 on the blood.

If this is food issue - then I get really confused with that. If he's not lasting 12 hours than I think I'm supposed to add a carb - right?

JUST A THOUGHT - but I was thinking that maybe we should try Vetsulin again. That has two dropping actions, correct?

I really don't know how you guys do this - it gives me such a headache trying to figure this stuff out.

But, you know me, never like to complain;)

BestBuddy
07-01-2009, 07:22 PM
Hi Pam,

Sorry I can't remember if you are feeding canned or dry. I do know that I fed Buddy mainly canned because too much dry raised his BG and kept it higher. For me it was a matter of getting the right balance of can and dry to make it work.

Jenny

We Hope
07-01-2009, 07:43 PM
Pam,

The differences between NPH and Vetsulin:

Human insulin is one amino acid removed from being a perfect match to canine insulin; pork insulin matches canine perfectly. Not having a perfect match sets up some insulin resistance, which is not always a critical problem. When it's not extreme, it serves to lengthen the duration of the insulin.

Before we were aware that Lucky's resistance was immune-mediated (destroying any insulin not just like his own), we tried beef insulin after human was a bust, in an effort to lengthen duration. Beef insulin is two amino acids away from a match to canine insulin; Lucky had the same poor reaction to it as to human.

We had a dog on another board who was started on Insuvet Lente (beef Lente), U 100. That worked too slowly for him. He was switched to Caninsulin/Vetsulin and he used that too quickly. The third switch was to human NPH insulin and that worked out fine for him.

U 100 insulin has a slower onset, peak and more duration than U 40 because of the strength difference. The dog for whom the third time was the charm made good use of the 1 amino acid difference and the U 100 strength of the NPH.

If you compare NPH and Lente insulins of the same species and strength, NPH has a faster onset and peak and less duration than does Lente.

Lente insulin is made up of 30% fast-acting semilente insulin and 70% long-acting ultralente insulin. Together in these proportions, they produce an intermediate-length insulin, just as NPH is.

http://www.ncbi.nlm.nih.gov/pubmed/9358402?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Pharmacokinetics of a porcine insulin zinc suspension in diabetic dogs.
Journal of Small Animal Practice October 1997

"Ten dogs with naturally occurring diabetes mellitus were injected with a highly purified porcine insulin zinc suspension [Caninsulin/Vetsulin] at a dose according to their expected requirement. Plasma insulin and glucose concentrations were measured at two-hourly intervals over 24 hours following injection. There were either one or two peaks in plasma insulin concentration: one at about four hours (mean 4.3 +/- 1.3 [SD]) and another at about 11 hours (mean 11 +/- 1.85) after the injection. The second insulin peak was seen in only eight dogs. Persistence of elevated plasma insulin concentrations ranged from 14 to 24 hours (mean 17.4 +/- 3.65). These results compare favourably with those published for other intermediate-acting insulin preparations used to treat canine diabetes mellitus and suggest that this preparation has useful properties for the successful management of many canine diabetics."

All dogs don't have two peaks with Caninsulin/Vetsulin; Lucky had but one and that was 6 hours after food and shot--this depends on the dog. If you have a look at Margaret and Lucy's curves, you'll see that Lucy doesn't have two peaks either; her one peak is 8 hours after food and shot.

What was the reason you stopped using Vetsulin? That might help determine if you should try it again or not.

Kathy

k9diabetes
07-01-2009, 09:35 PM
Pam,

I wouldn't necessarily change anything. With a dog who you can't home test blood glucose very easily, it's hard to make fine diet changes. Heck, it's hard to make fine diet changes even when you can home test blood glucose... And there's a lot about this curve that looks very very good.

The question is whether vet stress is playing into this at all.

If this curve was duplicated pretty reliably at home, he should have negative urine readings for much of the day. If that's the case, then I'd think about a tad more food or less insulin because of the 72.

If the urine tests don't seem to match the curve, then vet stress may be shifting the readings at the vet. And whether you do anything different depends on what the urine tests show.

Natalie

pgcor
07-02-2009, 06:14 AM
Thank you so much everyone!!! I really appreciate your input. Jenny, Pip is home fed a diet of chicken, green beans, zucchini and pumpkin. He's been on this diet since April of 08. Of course, he's getting a lot more volume then when we started!!!

Kathy, we stopped using the Vetsulin for two reasons - a situation, like now, of it not lasting a whole day started to happen - and then I broke a bottle causing me to run all over on a day our Vet was closed. I decided I would switch then and there because Humulin is available at 24-hour pharmacies - everywhere!

Our Vet's advice yesterday was to do nothing. But I did lower his insulin at night. Now, this AM his first urine was 500. Our Vet is very sweet, but really isn't all that savvy with this disease.

Natalie, our urine tests did match the blood tests at the Vet. Actually, for the first time in a few weeks, he was showing negative urine for the better part of a day.

This situation is exactly what happened the last time he went out of regulation. But then he just sort of "righted" himself. When I look at his curves over the past two years he's had some fairly low "lows" on both insulin types.

The worst lows he's ever had were a curve on 9/8 at a new vet that insisted we leave him there for the curve.

At 2:00 we stopped the curve and took him home. He was fighting so bad he injued himself. His first draw was 40 non-fasting with insulin, then 10AM
28 and Noon 51. I think he does go low from stress.

k9diabetes
07-05-2009, 12:23 PM
Hey Pam,

I was just going through your pictures... do you have larger versions you could post? I'd love to see them in more detail.

It's great to hear that you've been seeing some negative urine tests again and that the results of the curve seem to match the home readings. Since insulin doesn't work like a clock, there is some variability in how long it lasts, all connected to with activity, stress, temperature.

I think there are more wobblers out there than we sometimes realize... I don't know, you know, it seems like the textbooks and even sometimes we here talk about blood sugar levels like it is more stable and predictable than I think it is in many cases. Chris wandered, Forbin wobbles...

If we were working with these guys 10 years ago, we wouldn't be testing them and we wouldn't know that they wobbled or wandered. Because we monitor them closely, we see the variations - which is not the same thing as them being abnormal. As more and more dogs are tested fairly frequently, we may find that wobbling is the norm.

Natalie

eyelostit
07-06-2009, 01:17 AM
Hi Pam,

All I can think of regarding the 72 is to add maybe 2 teaspoons of brown rice to Pips food.

Hope this helps :)
Dolly

Margaret Boyle
07-06-2009, 08:29 AM
Thank you so much everyone!!! I really appreciate your input. Jenny, Pip is home fed a diet of chicken, green beans, zucchini and pumpkin. He's been on this diet since April of 08. Of course, he's getting a lot more volume then when we started!!!

Kathy, we stopped using the Vetsulin for two reasons - a situation, like now, of it not lasting a whole day started to happen - and then I broke a bottle causing me to run all over on a day our Vet was closed. I decided I would switch then and there because Humulin is available at 24-hour pharmacies - everywhere!

Our Vet's advice yesterday was to do nothing. But I did lower his insulin at night. Now, this AM his first urine was 500. Our Vet is very sweet, but really isn't all that savvy with this disease.

Natalie, our urine tests did match the blood tests at the Vet. Actually, for the first time in a few weeks, he was showing negative urine for the better part of a day.

This situation is exactly what happened the last time he went out of regulation. But then he just sort of "righted" himself. When I look at his curves over the past two years he's had some fairly low "lows" on both insulin types.

The worst lows he's ever had were a curve on 9/8 at a new vet that insisted we leave him there for the curve.

At 2:00 we stopped the curve and took him home. He was fighting so bad he injued himself. His first draw was 40 non-fasting with insulin, then 10AM
28 and Noon 51. I think he does go low from stress.

Hi Pam,
I have not spoken to you for a wee while. I see you are having problems with some lows yes it is very scary our ( Lucifer) the little devil likes to keep me on my toes with some real lows at her nadir time I am counteracting it with some honey.
I cannot give her more food as this will make the other numbers higher and I do not want to increase her insulin. It is a catch 22 situation.
She is a bit like Natalie's Chris was. The lows do not seem to set the counter regulatory hormones off but I do get scared.
I am doing a curve tomorrow so we will see what she is doing.

I do hope you get PIP sorted out Lucy has had a few 30 40 and 50,s But I am hoping it is beginning to sort itself out:rolleyes:

Hugs to the both of you:D

pgcor
07-06-2009, 12:09 PM
Thank you Margaret,Dolly and Natalie!

First, Natalie are you talking about the pictures of Pip and Newman? I'm not sure how else to post the pictures? I'll look around and see if I can figure out how to do it.

Dolly, we used to put brown rice in his food and he did not react well to it. He always seemed to overreact to carbs, but I can try again. I was thinking of adding it, but just to his evening meal. What I thought might work was to raise him back up to 7 1/2 units at night (he's at 7 right now) and then add a teaspoon of brown rice to his evening meal. But I fear I may be just back in the same place, you know? He still wakes up with 500 - 1000 urine in the AM. He never did this. Was always negative. I know some people find that scarey, but his curves showed fasting glucose just below the renal threshhold (not always, but mostly) and I thought we had excellent regulation.

Thank you for wishing us well Margaret. Your support means a lot to me! In fact, I think I would be lost if it weren't for this forum. Good luck with the curve tomorrow!

Pam

k9diabetes
07-06-2009, 09:51 PM
Yes, I wondered if you had larger image files. The ones in your gallery are pretty tiny and I would love to get a better look at Pip and Newman!

Natalie

pgcor
07-07-2009, 06:46 PM
Hi Natalie! I don't know what I did differently but I reloaded the pictures and now they're bigger. :)

k9diabetes
07-07-2009, 08:31 PM
Ah, much better!! Now I can see their faces!

So is Newman a mix?

Natalie

pgcor
07-08-2009, 06:53 AM
Hi Natalie: Yep, Newman's a mix, but we don't know what. I suspect he has a little Pit Bull in him, but I really don't know.

Here's how we picked our dogs - When we went to shelter, Pip jumped up on my husband's lap and just stayed there. Five years later we went back to the shelter and Newman kept jumping up and crying everytime I walked by....

I have always loved animals all my life - I have no special breed or size that I favor.

k9diabetes
07-09-2009, 08:38 AM
LOL... I know. I wasn't involved in choosing Chris as I didn't live with them then. Cats have always come to me rather than me choosing them - which probably explains why my cats are so odd.

There was something about Jack's photo that caught our eye. The one thing we tend to choose by is size as we gravitate to medium to large dogs. Chris was about 60 pounds and Jack is the same height but leaner build at 53 pounds.

When I looked at the SPCA dogs on Petfinder that night, he was about the right size and about the right age - we wanted young but not a puppy that would need constant potty supervision.

For some reason, every time a calm mellow cat or dog shows up at our house as a stray, I can't keep them cuz I already have a houseful of excitable, high strung or special needs critters. I have given away some of the nices dogs and cats!!

Natalie

pgcor
07-12-2009, 11:37 AM
If you remember, Pip's most recent curve wasn't all that bad and he remained under the renal threshold for most of the day. I did add rice to offset the low number, but that did not help at all. Since his curve he's had no negative urine at all. I just raised his insulin about a 1/4 unit (as far as I can tell). But his urine is 1000 - 2000 all the time.

I've also tried several times during this period to get blood and, as usual, been unsuccessful. Now, I'm having problems giving him his shots. He is very out of control.

Money is getting tight, which is why I keep persisting in blood testing even though he's out of control. Actually, and I hope this doesn't sound bad, but I'm getting really annoyed with this. You can believe me when I say I am as calm as possible and my husband cradles him like a baby.

Having said this, I'm wondering if we should see a Specialist again. Our Vet just doesn't know what to do and says to just keep him where he was. "Maybe he'll re-regulate" is her comments to us.

I know insulin resistance doesn't happen until we are over 1/2 unit per pound. So I think that's not it.

I've removed the rice from his food and kept his insulin at about 1/4 unit higher, both AM and PM now and still no change.

He is so hyper, he's driving me crazy!!!!! Today, I had to tackle him in the backyard to get a ground squirrel out of his mouth - and he's still wound up as tight as you can imagine.

I think the higher sugars are making him more hyper than usual. Any thoughts, anyone?

I'm going to try and persuade my husband to take him to another holistic Vet. Our first experience with one was horrible. But I think I need someone to advise about food?

I don't know......

eyelostit
07-12-2009, 11:57 AM
Hi Pam,

I can understand the getting annoyed with all of this ;), I can remember well my going out of my mind phase which was a long time.

Ok, if you want to change the diet a bit Pip has been eating a meat and vegetables that has been constant for quite sometime right?

The urine figures should change if you are not using the rice anymore and you are trying to home test now correct?

What are the amounts of each food you give Pip?

Dolly

k9diabetes
07-12-2009, 02:15 PM
It's hard when money is tight... one thing I'd consider is thyroid level with this abrupt overactivity/reactivity. Thyroid levels can do really strange things to the personality. Be sure they do the Free T4 with Equilibrium Dialysis so they get an accurate result.

If you can swing it, a specialist consult, to me, is always a good thing. Just a second pair of eyes can be really helpful. Sometimes it doesn't produce anything but the knowledge that you're already doing all that can be done. But even that is useful information.

If this represents a change in his personality, then it's worth considering that there could be a hormonal imbalance like thyroid or pain somewhere that's ramping him up. That would also explain the increasing blood sugar.

Any possibility that he actually feels good and that's why he's so hyper?

Just cuz you don't like the sugar in his urine tests doesn't mean he doesn't! ;) Some dogs actually seem to prefer to have somewhat higher blood sugar.

How high are the urine tests?

Natalie

pgcor
07-12-2009, 03:15 PM
Pip has stayed at 1000 urine tests all day today. We weighed him again and he's 22 lbs. on the dot. He gets the following meal twice per day:

10 ozs. chicken
6 1/2 ozs. green beans
6 1/2 ozs. of zucchini
1 oz. chicken hearts
3 oz. of pumpkin

I'm very meticulous about weighing each ingredient separately and then putting it into a container.

Natalie, Pip has always been a hyper dog, and he seems particularly hyper lately. But it's not enough for me to say it's out of character for him.

One thing I have noticed though....he's always gotten quiet after his insulin shot, but lately he has not been doing that. I also opened a new bottle of insulin, so it's not that either.

He's staying hyper for the entire day.... I know my neighbors are thrilled. I have to let him outside and stand with him because he barks like a nutcase at everyone and everything that blows by.

Natalie, I will talk with our vet about the thyroid test. Thank you so much for the suggestion.

Pam

k9diabetes
07-13-2009, 09:14 PM
Do the high urine tests coincide with the new insulin bottle? Could be the new one that is bad.

pgcor
07-14-2009, 10:06 AM
Hi Natalie: I wasn't even going to post this because I feel like I'm slowing being driven crazy (Like Ingrid Bergman in Gaslight).

Yesterday, Pip remained negative for most of the day????!!!! First time in months - this was on 7 1/2 units of insulin. He actually stayed negative through his last urine check just before we fed him for his PM shot (5:45 PM). He gets 7 units at night. He's been on 7 1/2 and 7 now for quite a while.

He was still negative around 9PM, so the insulin had to be working. This morning he was 2000. Now I'm wondering if I should add rice to just his evening meal if he's negative all day?

I really don't know what to think.:confused:

k9diabetes
07-19-2009, 11:04 AM
Pam,

How's Pip doing now? Have you been driven over an edge yet? :rolleyes:

Natalie

eyelostit
07-19-2009, 07:54 PM
He gets the following meal twice per day:

10 ozs. chicken
6 1/2 ozs. green beans
6 1/2 ozs. of zucchini
1 oz. chicken hearts
3 oz. of pumpkin

I wasn't even going to post this because I feel like I'm slowing being driven crazy (Like Ingrid Bergman in Gaslight).
Pam


LOL or Bette Davis in "Hush Hush Sweet Charlotte";)

I think I would add the rice too.

I hope all is going well.

I'd hate to advise on a food change without seeing some of your bg readings, I think you were having a hard time getting the blood to test.

With Pip getting hyperactive alot, I think I would keep with a little rice or cooked regular oatmeal in his diet.

Hope this helps.:)
Dolly

pgcor
08-19-2009, 11:09 AM
I hate to, but I have to ask this question....how in the world do you get an accurate weight on your dog? My Vet keeps saying her scale isn't accurate, but it's close. We try to weigh Pip at home but we get different readings, just like at the Vet.

First I weigh my husband (I just can't bring myself to get on that scale, but since I weigh the same as high school, why bother) then I weigh Pip.

Last week it looked like he weighed 23 lbs. Now it looks like 22. There's no way he lost a pound over a week and his need for insulin is slowly increasing. He's up to 9 units AM and PM.

If he is still 22 lbs., I can't account for the insulin? Repeat after me...I hate diabetes!

k9diabetes
08-19-2009, 10:12 PM
I say take him to the grocery store and put him in the bucket of a produce scale! LOL

Why isn't the vet's scale accurate?

We have a bathroom scale that measures in tenths of a pound - maybe buy a bathroom scale with a finer calibration like that.

Natalie

pgcor
08-20-2009, 05:47 AM
Hi Natalie!

Oh, the Vet says her scale isn't accurate to the ounce that you need with little dogs. We are going to see another Vet. This is holistic Vet in an area not far from us. Hopefully #7 is the charm! Pip's eye is bad again and so we're taking him to the eye doctor first. I guess we're going to have to fight with this dry eye all the time. He gets tacrolimus and another eye drop I can't remember - every day - but all of a sudden...:eek:

It's always something. I look into a different bathroom scale - I didn't even know they got to such a fine calibration! Thanks Natalie!

Pam

pgcor
08-21-2009, 08:45 PM
Well, Pip needed another eye surgery. Keratotomy on his other eye. Poor guy, he's really out of sorts. The good news is that this same procedure was done on his other eye last year and it's still doing pretty well.

He's needed a few pain pills but has done quite well without the collar. I'm hoping he opens his eye in a few days. Boy, he sure has been put through the wringer with his eyes. I'm learning dry eye can be a lot worse than it sounds.

Margaret Boyle
08-22-2009, 07:56 AM
Well, Pip needed another eye surgery. Keratotomy on his other eye. Poor guy, he's really out of sorts. The good news is that this same procedure was done on his other eye last year and it's still doing pretty well.

He's needed a few pain pills but has done quite well without the collar. I'm hoping he opens his eye in a few days. Boy, he sure has been put through the wringer with his eyes. I'm learning dry eye can be a lot worse than it sounds.

Hi Pam,
Sorry to hear Pip had to have more eye surgery. Lucy has had dry eyes since before she was diagnosed in 2007.

I have to put eye ointment in twice a day in both eyes, even if she has cataract surgery she will still have to have the Optimmune as at the moment her dry eye is clear but the minute you stop using the treatment it comes back.
The Opthalmologist was explaining it all to me as he checked her dry eyes when we were in and he said it was really good but she would be on Optimmune indefinitely.

Yes Pam it is is something that cannot be left untreated. I thought at the beginning once it got a bit better the eye ointment would stop, but this was not the case. It is the ointment that prevents it from becoming worse.

I hope Pip will start to feel better soon, and his eye opens soon, what the poor souls have to go through.:(

Hugs to you both

ladysmom06
08-23-2009, 05:19 AM
Hi Pam,

Well, Pip needed another eye surgery. Keratotomy on his other eye. Poor guy, he's really out of sorts.

Sorry to hear that Pip needed surgery. Hoping he feels better soon. Hugs to you and Pip.

pgcor
08-23-2009, 10:11 AM
Thank you Margaret and Lynne! I appreciate all your good thoughts! Margaret I assume Optimmune must be like Tacrolimus, which is what Pip gets. He gets Tacrolimus in the AM and Flurbiprofen at night. I felt a lot better hearing that the procedure from last year and the drops have kept his other eye in good shape. After hearing diabetes, I didn't panic when I heard dry eye....but at least I don't have to stick him to take care of this problem!

For those who don't know dry eye - I never noticed anything except what I thought was "sleep" in his eyes. Only later did I find out that it's not normal.

Pip's eye partially open yesterday and he's holding it open for longer periods of time, so I think he's getting better.

k9diabetes
08-24-2009, 08:23 PM
Is this actual surgery or is this the punch or grid that they can do as an outpatient?

Chris had numerous procedures as an outpatient because his corneas didn't cement properly so any time he got an ulcer it wouldn't heal until we did a keratotomy. His first ophthalmologist did grids of fine scratches but most of his were "punctate" where the doc punched little holes in the cornea.

As I understood it, it helped to give the cornea smaller areas to fill in and cement. They always worked wonders for Chris' corneal ulcers.

Pip could use a break, no doubt! Not to mention you! ;)

Natalie

pgcor
08-26-2009, 04:25 PM
Hi Natalie:

The eye doctor called it a surgery and I never thought to ask anything more. It is a keratotomy, at least that's what the paperwork says. He explained to us that the eye is made up of layers and that he shaves a few layers off Pip's eyeball to help reduce the inflammation from dry eye. The eye doctor works in a hospital/clinic environment and our regular Vet can't do the procedure. That's all I know! I don't even know what you just explained! LOL However, I think I will need to ask more questions now. It's also $700!:eek: But I love him!

Pam

k9diabetes
08-26-2009, 05:35 PM
Could be it was more like a surgery, especially given the price. We didn't pay anything like that and Chris was done in a matter of minutes.

Here are some good diagrams of the two procedures:
http://books.google.com/books?id=fGJwfJWCc-kC&pg=PA133&lpg=PA133&dq=keratotomy+veterinary&source=bl&ots=kIwoBk9QAt&sig=mdywdpPyluqn22dEXY6nWnplDb8&hl=en&ei=m9OVSrCZDJqusAP5wqmCBQ&sa=X&oi=book_result&ct=result&resnum=7#v=onepage&q=&f=false

I believe keratectomy is actual surgery - something we never had to do.

Here's a little better description of the diffeence - most are in journals where you can't readily read the article.

http://www.cvm.ncsu.edu/vth/clinical_services/ophthal/indolent_ulcer.html


A grid keratotomy is a procedure in which the tissue under the diseased outer surface of the cornea is altered. This procedure helps to promote healing and also may require repeated procedures. A superficial keratectomy surgically removes all of the underlying diseased tissue and is generally successful with a single surgery.

pgcor
08-27-2009, 06:07 AM
Thank you for posting this information Natalie. I'm a little concerned that either I do not fully understand what is wrong with Pip's eyes or we are paying too much for the procedure.

I need to look into this further, as this is not the first time we have been told we're paying too much at this facility.

Thank you!

k9diabetes
08-27-2009, 08:01 AM
The keratotomy is a really minor procedure. If the dog is calm, as Chris was, they don't even need any sedation. Which is why he was in and out of the keratotomy in about fifteen or twenty minutes. He had these done a half a dozen times in his life. One eye had basically the entire cornea done with the punctate keratotomy and finally, after months of messing with it, the corneal ulcer healed up.

But the keratectomy is "surgery" rather than just punching or scratching the cornea and would involve putting them under.

Natalie

eyelostit
09-02-2009, 05:54 PM
Hi Pam :)

Sorry about Pip's eye, how are you two doing now?

Dolly

pgcor
09-05-2009, 03:55 PM
Thanks for checking up on us Dolly! Pip needed another procedure last Thursday as his eye seemed to worsen. The eye vet was worried about infection, but that wasn't it. Apparently there was more to remove toward the bottom of the eye.

Pip is doing much better now, but this really took the wind out of his sails! I never thought I would be concerned about "no running and barking/screaming"

His eye never looked different from these procedures, but is rather bluish gray looking now. He's due back on Thursday for a follow up visit.

You are very sweet to check on us! Thank you Dolly!

Pam

k9diabetes
09-06-2009, 10:54 AM
Sorry to hear Pip had to have another surgery. I believe they wind up with scarring of the cornea from keratotomies or keratectomies.

We were so frustrated with Chris' corneal ulcers - poor dog got no use of his eyes and was having to wear a cone and have all these procedures. If the major keratotomy hadn't healed it up, we were on the verge of just removing the eye. He had worn a cone for months and would never have had to wear it again.

When we did finally get it to heal, he never had another. Weird but good.

Natalie

eyelostit
09-06-2009, 09:27 PM
Hi Pam, :)
Things sound better, let us know what happens Thursday.

LOL no running or barking, you do miss the things they do when they aren't feeling good.

dolly

Margaret Boyle
09-07-2009, 05:05 AM
Pam,
I hope Pip is a lot better now, and has got over all those procedures.:)

Hugs to you both

pgcor
09-09-2009, 06:56 AM
I never thought I would be posting this question, but Pip refused to eat this morning.

If this was ANY other dog, I wouldn't panic, but he eats like a pig. When he was eating kibble I had to put a ball in the dish to try and slow him down. As some know, he's eaten his squirrel kills, whole.

First, I hand fed him until he would take no more food. I gave him 1/2 the insulin dose. My husband is home all day with him.

I brought all my books to work with me to try and figure out what might be wrong. His eye is much better since his second procedure and is fully open. So, I would be surprised if pain in the eye were the problem. In any case he has a follow up visit to the eye doctor tomorrow.

I read about kidney problems, and I have noticed he pees more in his male wrap (diaper). But he has had ups and downs with that, especially if he's hostile toward our other dog. He tries to mark everywhere.

A couple of weeks ago, he had a little bout of this "loss of appetite", but after a few minutes of staring at it, he ate all of it.

I haven't been able to come up with any issues other than pain or kidney problems that could cause his lack of appetite.

I'm not sure what to do? Would a blood workup show kidney problems? I think BUN/CREA is the marker correct?

If anyone has any thoughts, please let me know. Thanks a bunch!!!!!!

We Hope
09-09-2009, 08:05 AM
Pam,

I would try for a Chem 21/Full Panel blood workup when Pip's at the vet tomorrow because it should tell you if there's any kidney function problems and anything else that might need taking care of.

http://www.petplace.com/dogs/what-do-those-words-mean-diagnostic-tests-and-procedures-2/page1.aspx

HTH!

Kathy

k9diabetes
09-09-2009, 08:17 AM
I too would start with a blood panel and a physical exam - and have the vet take a look at the teeth and mouth.

Natalie

pgcor
09-10-2009, 05:55 PM
Well, the eye still isn't healed:( More drops. The eye specialist said it takes time when you can't use steroid drops. I don't remember it taking this long the last time. But maybe I'm just anxious. Plus, there are so many drops I have a list made out on the cabinet. I can't remember anything anymore!

Pip still needs coaxing to eat, which really bothers me. We have a vet appointment for 9AM on Saturday. Maybe his eye hurts more than he lets on. I've heard that it's natural in dogs to hide illness or injury as it could kill them in the wild.

Will check his blood, teeth and mouth. Thanks Natalie and Kathy! Everything written down for Satuday!

Thanks for checking in on us Margaret and Dolly. Margaret, I'm sending good thoughts your way - I just know the surgery will go well! If I can do all the drops so can you!

Margaret Boyle
09-11-2009, 04:49 AM
Thanks for your kind thoughts Pam.

I do hope Pip begins to feel better as it is a worry when they are not at themselves. It is marvellous how everyone knows their own dog's habits.

You just seem to know when they are not so good.

Try not to worry Pam i am sure his eye will heal it may take that bit longer but
he willget there:)

Hugs to you both.

pgcor
09-12-2009, 03:58 PM
I just received a message from our Vet regarding Pip's blood work and urinalysis. While I don't have any numbers yet, she just said his kidney tests were normal, urine was properly concentrated so she know the kidneys are working. The only value that is different is the liver value or values. She didn't say which ones or by how much they are off normal. She wants to discuss that with us on Monday.

Pip has had a rough couple of months trying to get re-regulated and I'm hoping that his liver values may only be temporarily elevated due to that.

I guess i'll have to wait until Monday. Did I mention how much I hate diabetes lately? If not, let me reiterate that now.:mad:

k9diabetes
09-12-2009, 10:31 PM
I hope it's just the "diabetes" elevations and not something more serious. I'll be looking for news on Monday.

Natalie

k9diabetes
09-12-2009, 10:35 PM
You and Pip have really had a time of it lately. I don't know if Pip's had to wear the cone all this time but when Chris had to wear it for a long time we were getting really stressed and discouraged because it made him so miserable. We just about opted to take that eye out since he couldn't use it anyway as at least he wouldn't have to wear the cone any more.

I say cut yourself some slack on his regulation. He's had a lot going on and that's going to screw up his blood sugar. It's okay to get what you can get with the blood sugar even if it's not exactly what you want.

Natalie

forloveofandy
09-13-2009, 07:46 AM
Pam just catching up on all this with our Pip.
I will be checking on Monday for more details.

I know what you mean about lack of appetite. This would scare me too since Andy would sooner chew his own leg off than miss a meal. :D

I will look in on Monday. Give that boy a big hug from us.

pgcor
09-14-2009, 04:54 PM
Thanks for checking on us! Anne, I'm glad to see that you've gotten to the bottom of Andy's allergy problems! That's a big sigh of relief.

Talked with our Vet today and these are the levels she's concerned with:

ALKP 340 (range is 10 - 150)
ALT is 201 (range is 5 - 107)
AST is 61 (range is 5 - 55)

She did run the specific pancreatitis test but is treating Pip as though he has it. We are to give him Clavamox and check back with her on Friday and Monday. He was vomitting throughout the weekend, so she's hoping this will help.

His BUN/UREA was also high at 38 (range is 7-27). But she didn't think this marker was anything to be concerned with. But, if I'm not mistaken...I was told that if the PHOS is high than he is getting too much protein. His PHOA was 6.1 (with a range of 2.1 - 6.3). This is normal, but higher than the last time his blood was drawn.

I did not see these results until I got home from work so haven't asked her about it yet...

If Pip is not better by Monday she is recommending an ultrasound.:(

pgcor
09-15-2009, 05:39 PM
Okay, I looked and looked and finally found where I got the phosphorus information from. My old friend Carla told me about that.

Does anyone know a good kidney supplement to add to his food or how to cut down on protein in his diet? What do I replace it with?

I'm getting so old it's hard to remember what I've learned and now who I learned it from!

If anyone knows, I would appreciate it!

forloveofandy
09-17-2009, 08:11 PM
Pam how is Pip now? Is he still throwing up? Is it ok to give him some Pepcid AC? I remember a discussion with Carla about restricting protein because of kidney issues. She said it was not quantity but quality of the protein. We need to feed protein that is more digestible. I have Carla's email addy. I will send it to you in a private message.

This is an excerpt from Pet Education website.

Are high protein diets harmful to my dog's kidneys?

A. A rumor has been going around that high protein diets cause kidney disease. This rumor is false. High protein pet foods are NOT harmful to a normal animal's kidneys. As an animal's body digests and metabolizes protein, nitrogen is released as a by-product. The excess nitrogen is excreted by the kidneys. A high protein diet produces more nitrogen by-products and the kidneys simply excrete the nitrogen in the urine. While you may think this would 'overwork' the kidneys and lead to possible kidney damage, this is not true. The kidney's filtering capabilities are so great that even one kidney is sufficient to sustain a normal life. There are many pets - and humans - living perfectly healthy lives with just one kidney.
The myth that high protein diets are harmful to kidneys probably started because, in the past, patients with kidney disease were commonly placed on low protein (and thus low nitrogen) diets. Now, we often put them on a diet that is not necessarily very low in protein, but contains protein that is more digestible so there are fewer nitrogen by-products. These diet changes are made merely because damaged kidneys may not be able to handle the excess nitrogen efficiently. In pets with existing kidney problems, nitrogen can become too high in the bloodstream, which can harm other tissues.

Unless your veterinarian has told you your pet has a kidney problem and it is severe enough to adjust the protein intake, you can feed your pet a high protein diet without worrying about 'damaging' or 'stressing' your pet's kidneys. Also, you are not 'saving' your pet's kidneys by feeding a low protein diet.

forloveofandy
09-17-2009, 08:18 PM
Darn I could not find her private email addy. Must have deleted my old messages. You could send her a message on Yuku. Just click on one of her old posts. Not sure if she checks it anymore. I have not seen her in a long time.

k9diabetes
09-17-2009, 09:42 PM
As long as the phosphorus is in the normal range, even though it's on the high end, I wouldn't worry about it. Normal means just that so should not be an issue.

Those values are not extremely high either... does she feel it's a serious problem?

Chris' AlkP was around 250 just from his diabetes when he was first diagnosed and poorly controlled. Once his regulation improved, it came down into the normal range.

And his Bun/Urea in 2008 was 32-34 for a while in 2007-2008. At one point his BUN was 55. This was after an injection of Lasix.

They weren't particularly concerned about his kidney function since his urine was properly concentrated. The more we used Lasix, the diuretic for his heart disease, the worse his kidney values got. So we went to using it only sporadically if he was coughing and his kidney values improved.

I don't believe that any of these values are severely elevated.

How is he doing now?

Natalie

pgcor
09-18-2009, 08:08 AM
Hi Natalie and Anne - Thanks for your responses!!!!!

I didn't want to contact Carla as I think she's quite busy with her practice now. Not much on line. We talked several months ago about a possible kidney supplement if his phosphorus levels kept rising. But Natalie, the Vet doesn't think there's an issue with his kidneys. She said what you said - the urine was properly concentrated. I just don't like those numbers consistently increasing.

The liver values took me by surprise as Pip has not had any issues with those since we added Sam-e to his diet. The Vet said we needed to watch those values - and to call her today and Monday and let her know how Pip is doing.

Pip hasn't thrown up since being on Clavamox, but he keeps waking me at around 3:30 to go outside. He urinates and then eats grass - so I think he still feels a little sick.

Having said that though - for some reason his face and general demeanor make me think he feels better. Just a feeling.

k9diabetes
09-18-2009, 09:23 PM
I hope you're right! It's good to hear that he seems better.

I have come to learn after a lot of lab tests that even slight elevations aren't usually a problem. It's when the numbers really start to climb that you have to worry.

Natalie

ladysmom06
09-19-2009, 05:53 AM
Hi Pam,

Pip hasn't thrown up since being on Clavamox, but he keeps waking me at around 3:30 to go outside. He urinates and then eats grass - so I think he still feels a little sick.

Having said that though - for some reason his face and general demeanor make me think he feels better. Just a feeling.

Sorry that Pip hasn't been feeling well but glad to hear that he's feeling better. Hoping that he continues to improve each day. Hugs to the two of you.

forloveofandy
09-19-2009, 09:22 AM
Pam here is an article on protein and kidney, quality of protein etc.

http://www.dogfoodproject.com/index.php?page=protein_myth

pgcor
09-20-2009, 07:03 AM
Thanks Anne, Lynne & Natalie - Maybe I worry too much? I did know about the "old wive's tale" about protein and Pip does get homemade food. His protein source is white meat chicken. I just don't like the numbers going up...and when I charted the numbers they have been steadily rising since he was diagnosed. That is the BUN and creatinine numbers. His phosphorus numbers were up only on this last test.

But, Natalie - I get your point. He does have diabetes! The good news is that he does seem to be getting back to his old self. Sometimes I wish I would have gotten him into agility training - he is, by far, the fastest running dog I've ever had. When he feels good he races around the yard at a lightning pace, which is what he was doing last night. Yeah!

eyelostit
09-20-2009, 08:06 PM
Hi Pam,

This is a good group, they are nice people and are up to date with canine kidney problems, they will no doubt want you to post your blood test results.

http://pets.groups.yahoo.com/group/K9KIDNEYS/

Dolly

pgcor
09-22-2009, 09:01 AM
Thank you Dolly!!!! Glad to see Niki is doing well - just a few "high ones" is great. The last curve you posted was perfect and made me very very jealous! ;)

pgcor
09-23-2009, 07:56 AM
Hi Dolly - I contacted the K9 kidney board. Thank you for that. Pip leaked urine last night and vomitted again. He's on Clavamox already, so who knows. We have to bring a urine sample into the Vet again today.... We have a holistic Vet appointment on 10/27. Can you believe that's the earliest they can get us in?

Anyway, thank you and I used your name as the reference, hope you don't mind.

Pam

k9diabetes
09-24-2009, 09:04 AM
Any news on Pip? I don't like that he's leaking urine and throwing up again... Poor guy.

Natalie

pgcor
09-24-2009, 11:22 AM
Hi Natalie - His urine results came back normal!! I really don't know what else to do? I asked my husband to get the results so I can chart them. He "spit up" only last night, but there was a small urine spot where he was laying again.

One more thing I will do is post the blood and urine results on the kidney site to see what they think. I did read that they advocate an over the counter supplement that binds to phosphorus, which may take the weight off his kidneys.

Otherwise, it would appear that his food is okay as are his supplements. :confused:

pgcor
09-24-2009, 11:39 AM
I just spoke with Pip's Vet, she said that his urine concentration was 1.009, which is a little worse than his last urinalysis (about two weeks ago). She said that's perfectly fine though as she would expect that type of variation depending on his sugar load.

Her suggestion was to monitor Pip's sugar and when he goes out of regulation again to call her and we would consider putting him back on Clavamox. She thinks his pancreas or liver may "act up" as in a chronic situation and therefore throw him out of regulation. I forgot to say that he seems to be doing better since being on Clavamox. His urine strips are mostly negative.

Since his "spit up" was orange yesterday she though maybe it was the pumpkin and to substitute it with peas. But, OMG, i don't want to touch his food again!!!!

I asked her about a phosphorus binder, and she was very adamant about not trying that as his phosphorus is still within the normal range, albeit high normal.

She cannot explain the urine leakage, as there is no infection based on these tests. Will get the data after work today.

We Hope
09-24-2009, 04:43 PM
Pam,

Not sure if this helps or not--Fleeman and Rand have been big advocates of the thought that subclinical pancreatitis is common in dogs with diabetes.

http://www.uq.edu.au/ccah/index.html?page=43505&pid=0

CHRONIC, SUBCLINICAL, EXOCRINE PANCREATIC DISEASE IS COMMON IN DIABETIC DOGS

LM Fleeman1, JS Rand1, JM Steiner2, and DA Williams2
1 Centre for Companion Animal Health, School of Veterinary Science, The University of Queensland, Australia; 2 GI Laboratory, Texas A&M University, College Station, TX

Kathy

Adding a link to an article about Urinary Incontinence in Dogs. The Proin they mention doesn't go well with diabetes.

http://www.examiner.com/examiner/x-7468-Providence-Pet-Health-Examiner~y2009m5d6-Canine-urinary-incontinence-in-dogs

http://diabetesindogs.wikia.com/wiki/Medication_warnings#Urinary_Incontinence

http://www.marvistavet.com/html/body_diethylstilbestrol__des_.html

http://a1272.g.akamai.net/7/1272/1121/20070914194107/www.drsfostersmith.com/Rx_Info_Sheets/rx_diethylstilbestrol.pdf

Diethylstilbestrol (DES) patient information sheet

pgcor
09-25-2009, 05:57 AM
Thank you so much Kathy! I've heard about chronic pancreatitis, but had assumed I would see more definitive symptoms - apparently not. Very interesting.

If I look back at the situation with Pip, he does seem to go out of regulation every couple of months (2 to 3 months). And we did suspect chronic pancreatitis at one time. We did try adding ground, powdered pancreas (pig) to his diet at least a year ago, but it seemed to raise his need for insulin. I actually stopped using it because I just kept having to tweak his dosage.

Using the antibiotics when necessary seems easier, but I hope it doesn't create more issues than it solves.

These issues are so much more difficult when you can't check blood. Stubborn little dog!

He's still on eye drops, but in his mind, he's done with them. The only way I can get the drops in is if I put a cookie in my mouth while I hover over him so he can see it. Then i have 2 seconds....

pgcor
09-28-2009, 11:31 AM
Okay, I feel like a pest...but i have to ask something. I've been researching chronic pancreatitis and other issues Pip has.

However, I can't find any information regarding an increase or decrease in insulin during a bout of pancreatitis.

Has anyone heard of needing more insulin during pancreatitis and then needing less when the disease abates?
My head is swimming from everything I've been reading lately. I've never felt so stupid in my life, but understanding this medical "stuff" does not come easy to me.

Unfortunately Pip is still vomiting and leaking urine and our Vet is at a loss. The most worrisome was over the weekend - and excuse for for being graphic - but he vomited part of his food and would not eat it. I've heard that's a bad sign with a dog. The best I can do is take him to a holistic Vet, but she cannot see him until the end of October.

Thanks for reviewing this!!!!!!

We Hope
09-28-2009, 12:18 PM
Pam,

Let's see if this works and there's only a bit of "med stuff" to read. :)

Pancreatitis is an inflammation of the pancreas. The inflammation doesn't necessarily stop at the exocrine portion which controls digestion, but can also involve the endocrine part, which controls insulin production, etc. This is how it's possible for pancreatitis to be severe enough to cause diabetes and also how a bad bout of it can "jump start" the insulin producing beta cells in rare cases.

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

Vetinfo4dogs

Diabetes with rebound hyperglycemia

"Diabetes that starts out in conjunction with pancreatitis can be really hard to deal with at first since there are other pressures on the hormonal system from the pancreatitis. In addition, once in a while a dog with diabetes in conjunction with pancreatitis will suddenly experience a resurgence in insulin producing capability and a sudden "recovery" from diabetes."

http://www.vet.uga.edu/vpp/clerk/west/index.php

Diagnosing Pancreatitis in Dogs and Cats by Laboratory Methods
Laura D. West, DVM and Frederic S. Almy, DVM, MS, Diplomate ACVP
Class of 2007 (West) and Department of Pathology (Almy), College of Veterinary Medicine, University of Georgia, Athens, GA 30602-7388

Diagnostic Laboratory Tests

Complete Blood Count (CBC) / Blood Chemistry

"Additional findings include hyperbilirubinemia due to hepatocellular damage or cholestasis, hyperglycemia caused by hyperglucagonemia, stress, or damage to pancreatic islet cells, hypocalcemia associated with hypoalbuminemia or calcium deposition, hypercholesterolemia, hypertriglyceridemia, and hyperlipidemia."

So there you see how the inflammation can cause higher blood glucose levels. It's a lot like an infection in the respect that as you treat the infection with antibiotics, the inflammation becomes less and less.

With the various infections, you can need more insulin before the antibiotics have them under control. You may need more until that happens, and then as things return to normal, you can go back to your normal insulin dose, since the infection is no longer driving the bg's up.

Is it possible that you have an internist in the area you might be able to get Pip in to before October? The internist could have some answers about Pip's vomiting and leaking urine.

Kathy

k9diabetes
09-28-2009, 01:28 PM
Pam,

I haven't checked back but have they done an ultrasound of the bladder and pelvic area?

Natalie

pgcor
09-28-2009, 01:35 PM
Oh Kathy - thank you. I was afraid of this. Yes, there is a specialist I can contact. I'll give her a call.

Thanks again. BTW, are you a doctor or in a medical field of some sort? I would like you to say "yes" so I don't feel so stupid!:o

We Hope
09-28-2009, 01:51 PM
Pam,

I have to say no. ;)

The reason I suggested the specialist is because often, when the non-specialist is stumped, the specialist is not because he/she has seen more instances of whatever's wrong. It's not always a case of someone being so ill a specialist is needed except in the way that the specialist many times gets the opportunity to see the problems others can't solve, and therefore has more ready answers.

In "people practice", many family practitioners will refer patients to internists when they've hit the brick wall. We've had one as our family doctor for many years. My mother wasn't easy to medicate as she had a lot of sensitivities and issues with needed meds that don't bother most people a bit.

I've seen that good man know almost instantly what to either change or cut the dosage on time and again in the 20+ years my mother was his patient.

So going for a specialist consult doesn't have to mean there's anything seriously wrong with Pip; you're doing it to get the benefit of this man or woman's knowledge and experience in dealing with problems that are like his.

Think positive, OK? :)

Kathy

pgcor
09-28-2009, 05:07 PM
Thanks Kathy. I do understand what you're saying! Just wishing for smooth sailing!

Pam

eyelostit
10-04-2009, 02:15 PM
Hi Pam,:)

I hope things get better.

Let us know what the specialist says.

Niki gets off track I had a 250 past week then a 65 no rhyme or reason, just keeps me on my toes.

LOL don't get down on yourself for asking questions, I know how frustrating all this can get and we worry so much, better to post and talk to someone.

Take Care,
Dolly

pgcor
10-29-2009, 11:23 AM
I haven't been on for awhile - nursing my wounds, so to speak. Pip saw a new Vet recently and she thinks Pip has developed insulin resistance. I think the last time I posted his insulin requirements they were 8 1/2. Now he's at 9 1/2. If I'm correct we started the year at 6 or 7.

Our regular Vet is kind of disgusted with us as she does not believe Pip has insulin resistance, and can't understand we we're getting a "second opinion." It doesn't appear to me that he is in rebound as his urine tests (regardless of time are not all that high).

The new Vet gave us some very fine needles to use to check Pip's ears for blood. I begged my husband to try as I think I transfer my nervousness to Pip.

The new Vet weighed Pip at 22 lbs., but on our home scale he's 23. I thought the insulin increases were due to his gaining weight. He started the year around 21 lbs., so I know he's gained some weight. Plus, he's heavier to pick up and his ribs are not so prominent.

The new Vet is holistic and gave us some supplements that are designed to lower his insulin requirements.

She took him off the probiotics I had him on and prescribed a different one (without plant extracts). She thought the plant extracts were more harmful than good for him? I don't know....Anyway, he'll start taking another medication in a week and forgive me I can't remember the name.

She added another set of eye drops and gave us the name of another opthalmologist that may be significantly less expensive than our current one.

She gave us some instructions for massaging Pip to try and deal with inflammation, especially in the kidneys, liver & pancreas.

She's a very nice woman, but some of these things seem a little weird to me.

But I guess I have to pursue whatever avenues are open to me. And I did see his liver values improve remarkably from the Sam-e and Milk Thistle...so we'll have to see what happens.

I see the ups and downs everyone is dealing with and I truly wish I had a magic wand to help us all.

Always thinking about you good people here and always hoping to read ONLY good things for our dogs!

Pam and Pip

BestBuddy
10-29-2009, 01:48 PM
Hi Pam,
I just wanted to say that I don't think should be worried about the "high" insulin dose. I still struggle with the lb to kg conversion but I worked out that at 22lbs Pip is just under 10kg and Buddy's specialist once said to me that most of the dogs he was treating were getting their weight in kg in insulin. Buddy was around 5kg and got about 5iu. If Pip gains weight then the insulin will probably need to be raised too.
Jenny

k9diabetes
10-29-2009, 08:19 PM
Hi Pam,

You have been on my mind as we have a fairly new member of the Min Pin family who could use your support.

As far as insulin resistance... well, he's so far from the textbook definition of insulin resistant that I don't really know why it's being suggested...

9.5 units is a very typical dose of insulin for a 22-23 pound dog.

The definition is a dog who, on 1 unit of insulin per pound, still has basically uncontrolled blood sugar - 400s, 500s all day long - or a dog who needs significantly more than 1 unit per pound to regulate.

I consider half a unit per pound - barely where Pip is - as probably an averge insulin dose.

And it is common for more insulin to be needed when the dog gains weight.

So my main concern is what is happening with Pip... is he still having all of the same problems?

If he's still leaking urine there are other potential causes and admittedly some of them are scary. I would have an abdominal and pelvic ultrasound done to look for problems in and around the bladder, along with other areas.

How does he seem to be feeling?

The other thing that concerns me is that the first vet is miffed... I can understand her being concerned about the idea of insulin resistance as I would agree that he doesn't look resistant to me. But she hasn't solved the problem or answered the question either. So it makes sense to refer to a specialist to see if they could make more headway.

Natalie

pgcor
10-30-2009, 06:57 AM
Thank you Jenny and Natalie! I agree about the insulin resistance, but was hoping for some help with supplements from this holistic vet. His BUN/Urea numbers have been steadily increasing.

Natalie - Pip seems fine to me and has been playing with Newman more. However, he does still have urine leakage every so often. It's unclear at times whether he's marking or leaking. But you're right - I've been putting off the ultrasound because of the expense.

I think one of the reasons our Vet was "disturbed" with us is the "holistic" part of the equation. She doesn't appear to know much about diet and supplements and I don't know if she puts that much stock in it either.

We do have a Specialist we've seen that was written up for her ultrasound skills. I guess I need to bite the bullet.

I would be happy to provide support to anyone owning a Min Pin!!!! Diabetic or not they are a handful!!!

One of these days I'm going to take a movie of him eating and show it to all of you. His craziness never ceases to amaze me!


Pam

eyelostit
11-01-2009, 12:34 AM
Hi Pam,:)

I have been watching your posts, let me know what kind of supplement the holisitic vet wants to give Pip.

Dolly

pgcor
11-01-2009, 11:02 AM
Hi Dolly!

We will start Pip on Serrapro next week. It's a short form of serratiopepdidase. It's supposed to help with inflammation. I've been reading about in online and doesn't seem to have any harsh side effects.

Pam

pgcor
11-09-2009, 02:19 PM
Well, we started Pip on Serratiopepdidase on 11/4 based on the advice of the holistic Vet. She thinks it will help with his alleged bouts of pancreatitis. I say alleged, because there's no proof he has it. Both Vets suspect it.

Last night he started dry heaving and he's been high in sugar all day. Our Vet wants us to call when he's like this and she'll give us Clavamox. He seems to have a pattern of this every month or so.

Isn't too much antibiotic bad? It does help him, but his pattern has been to require more insulin after these bouts of vomitting or urine leakage. Of course, that remains to be seen in this case.

This is very confusing to me.

Pam

pgcor
12-15-2009, 02:10 PM
I haven't been posting for a while as Pip has not been very well for the last few weeks.

We had to go back to the Vet yesterday. His blood work came back and although I don't have the papers in front of me, my husband said the Vet is worried and wants Pip to have liver xrays or a CT scan.

His ALT was 1211
AST - 279
AlK Phos 493
BUN 53
Cholesterol 392
Potassium 5.8
EOSINOPHIL 11
Lipase 720
Amylase 518

With the possible exception of the last two results, the remaining she says is too high.

She indicated that we need to look at his liver for nodules or growths.

I'm extremely freaked out here at work - but couldn't the elevated numbers mean undiagnosed Cushings too?

OMG - I feel like I'm in a daze...

He's been on milk thistle and sam-e since diagnosed two years ago. He continues to leak urine...

Our Vet is concerned about the new probiotic the holistic Vet gave us, but when I look back at his last tests in September his liver values were already starting to rise. He had not been to the new holistic Vet back then.

In September they were:

AlkPhos 340
ALT (SGPT) 201
AST (SGOT) 61

I'm extremely worried.

k9diabetes
12-15-2009, 02:30 PM
I have a reference to the following discussion of liver disease (it is getting a little bit old, will see if I have a newer one):

http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00128.htm

ALT vs. ALP—does their relative increases help determine the location of liver pathology (intra- or extra-hepatic)?

http://www.vin.com/Images/Icons/Bullet1.gif Serum enzymology is not particularly helpful in determining whether an animal has hepatic or post-hepatic disease. Post-hepatic obstruction of the biliary tract almost invariably causes secondary hepatocellular damage and hence both ALT and ALP will be elevated. ALP is elevated by both intra- and extra-hepatic cholestasis thus is increased in hepatic and post-hepatic disease.

http://www.vin.com/Images/Icons/Bullet1.gif The relative degree of increase of each enzyme is also not helpful; in fact, if ALP is substantially increased and ALT normal or only slightly increased, non-hepatic disease such as hyperadrenocorticism or exogenous corticosteroid administration is more likely to be present.

http://www.vin.com/Images/Icons/Bullet1.gif It is important to be aware that serum enzymes are not liver function tests and there is no correlation between the magnitude of the enzyme increase and the severity or reversibility of the condition. Occasionally, cases of severe liver dysfunction, e.g., biliary cirrhosis, neoplasia or portacaval shunt, may be associated with minimal or no increases in serum enzymes.


His ALT and AST have shot way up and the BUN is on the increase too so further diagnostics would definitely be helpful.

I'm sorry to hear the blood panel brought bad news...

Can they do an ultrasound? That would be far easier on Pip and less invasive than a CT scan, which would require putting him under.

Natalie

k9diabetes
12-15-2009, 02:43 PM
I can pull up some NAVC documents on diagnosing liver disease that I can't necessarily post because access may be restricted. I will email them to you.

Natalie

pgcor
12-15-2009, 04:05 PM
Thank you Natalie! I'm reading the documents you sent now. Also, thank you for the information on the CT - I didn't know Pip would need to be put under.

We called the Specialist and Pip has an appointment at 3:00 on Thursday. This particular Vet is a specialist in ultrasound. I'll certainly request it, if she doesn't.

Please say a prayer for Pippy. I know that positive thoughts help!

Thank you so much~!!!!!!! Pam

Patty
12-15-2009, 04:25 PM
Pam,
Praying for your Pip on Thurs!
Patty

CarolW
12-15-2009, 06:11 PM
Adding our prayers for Pip.

Tue, 15 Dec 2009 18:11:45 (PST)

pgcor
12-15-2009, 06:16 PM
Thank you Patty and Carol! It always feels good to know you're not alone!

Pam

k9diabetes
12-15-2009, 07:57 PM
Just thought I'd post what these tests measure from Pet Place(http://www.petplace.com/dogs/understanding-blood-work-the-biochemical-profile-for-dogs-2/page2.aspx)

ALKP is important in metabolism and is found in liver cells. High levels indicate bile duct obstruction, Cushing's, liver disease, certain cancers and may be due to certain drugs such as steroids or phenobarbital. Low levels indicate starvation or malnutrition.

AST is important in the breakdown and elimination of nitrogen. High levels indicate muscle damage, heart muscle damage, liver damage, toxin ingestion, inflammation and various metabolic disorders. Low levels indicate starvation or malnutrition.

ALT is also important in the metabolism of nitrogen and is most often associated with the liver. High levels indicate liver damage, toxin ingestion, Cushing's disease and various metabolic disorders. Low levels indicate starvation or malnutrition.

Margaret Boyle
12-16-2009, 02:55 AM
Just thought I'd post what these tests measure from Pet Place(http://www.petplace.com/dogs/understanding-blood-work-the-biochemical-profile-for-dogs-2/page2.aspx)


Pam,

All my prayers are with you and Pip for Thurs.

Marg

k9diabetes
12-16-2009, 09:41 PM
Thinking of you and hoping for some good news tomorrow...

Natalie

pgcor
12-17-2009, 04:56 PM
Thank you Natalie and Margaret - I so appreciate your support!

Pip had an ultrasound today and it was inconclusive. His pancreas still had food in it so she was unable to see it.

She ruled out some types of cancer but not lymphoma. He could still have an infection or chronic hepatitis too. She can't be certain without a liver biopsy.

I hope we've made the right decision, but we chose to give Pip a 2-week regimen of antibiotics (Baytril and Metronidazole). He will be retested at the end of two weeks. If his liver values have not improved then he must have a liver biopsy. There's no way to know how to treat him otherwise.

I want you to know how much I appreciate your support. I try to provide support, but frankly you all seem light years ahead of me!

Anyway, I'm not always so positive about the human race - but then there's all of you and I feel hopeful. It's tough taking care of the chronically ill - coming here has been a life saver!

THANK YOU EVERYONE! Hugs to you Natalie!!!!

Pam and Pip

eyelostit
12-17-2009, 08:19 PM
Hi Pam :)

I'm sorry to hear poor Pip is having a rough time, you as well :(

I hope the 2 weeks of antibiotics get Pip back in the pink. I know no doubt you are worried sick as I would be with Niki.

Hope everything goes well and Pip is feeling better.

Take care
Dolly

k9diabetes
12-18-2009, 09:40 PM
I'm encouraged that no big tumors or other scary things were found. I think your plan makes perfect sense. A biopsy is a more invasive procedure and it makes sense to try some early measures to see if you can resolve it first.

When Chris had what we ultimately decided was a TIA, the choices were TIA or brain tumor and he would have needed a CAT scan to check for the brain tumor. Nobody wanted to put him under to do that. So we went with the idea that it was probably a vascular problem and did a cardiac ultrasound to see if we could identify the source of the clot. There was something on ultrasound that they thought might be a clot so we treated with aspirin to thin his blood and left it at that. He was too old and frail to go through any treatment for a brain tumor so identifying one if it had been there would not have changed anything.

I so hope the antibiotics help! As I told you, I think, Bonnie's Crissy Ann the last year or so had some mysterious ailment that responded to antibiotics. No one knew what the antibiotic was treating but so what. It made her feel better and didn't do any harm.

Natalie

ladysmom06
12-20-2009, 05:13 AM
Hi Pam,

Sorry to hear that Pip hasn't been feeling well. How is he doing now? Hoping the antibiotics work and Pip is feeling better real soon. Hugs to the two of you.

pgcor
12-21-2009, 06:27 AM
Thank you Dolly, Natalie and Lynne!

We've made a follow up visit for another drug panel between Christmas and New Year. Pip is still leaking urine and no one can say if it's related to his liver values or not.

I wish I could say he was feeling better, but doesn't appear to be. But, he still has 10 more days on antibiotics, so I'm hopeful.

Thank you so much everyone! I wish all the very happiest of holidays!!!!!

Love, Pam and Pip

Margaret Boyle
12-21-2009, 08:00 AM
Thank you Dolly, Natalie and Lynne!

We've made a follow up visit for another drug panel between Christmas and New Year. Pip is still leaking urine and no one can say if it's related to his liver values or not.

I wish I could say he was feeling better, but doesn't appear to be. But, he still has 10 more days on antibiotics, so I'm hopeful.

Thank you so much everyone! I wish all the very happiest of holidays!!!!!

Love, Pam and Pip

Hi Pam,

Hopefully the next 10 days of antibiotics will see a change in Pip.:)

I am thinking about you and Pip and wishing you all the best, this cold weather does not help them much.

Positive thoughts Pam take each day as it comes and hope each day brings an improvement for Pip.

Hugs to you both:)

CarolW
12-21-2009, 08:03 AM
Pam - keep us posted on how Pip is doing. I really hope the antibiotics help him feel better.

Kumbi sends his love, along with mine.

Mon, 21 Dec 2009 08:03:17 (PST)

pgcor
12-21-2009, 11:12 AM
Thank you for caring Margaret and Carol!

Unlike many on this board - when things get tough for Pip - I like to stay in bed...:D

Just kidding, trying to stay as optimistic as a misanthropic pessimist can - LOL

Hugs back at you!

Pam and Pip

pgcor
09-22-2010, 11:57 AM
I hope you'll indulge me here as I'm feeling very worried.

After several agonizing weeks, I've finally scheduled a liver biopsy for Pip. It's risky, I know...but his liver enzymes have continued to rise and the specialist just doesn't know how to treat him - at least not without a diagnosis.

There's no guarantee that what they find they can treat, but I felt that Pip deserved a chance. He's been through so much and I hate to see him scared and in possible pain again but the idea of losing him slowly just didn't sit right.

I can only hope I've made the right decision. I love my dog and hope I haven't acted out of selfishness - you know what I mean?

I am so nervous that my hands are shaking on the keyboard! I have to have him at the surgical center at 8:00 AM this Friday. :(

PLEASE send your good thoughts his way. I really believe it works!

Soaphie & Sydney's Mom
09-22-2010, 01:21 PM
All of my good thoughts are coming your way!!!!!!!

Patty
09-22-2010, 01:34 PM
Awe Pam, I'm sorry he's still on the rise. What are his liver values now?

I know he's been on milk thistle and samE and the ultrasound was inconclusive. I take it the antibiotics weren't helpful either.

Chloe's Mom
09-22-2010, 02:07 PM
Oh Pam,

I am so sorry poor Pip is having such a time of it. I have been away from the computer quite a bit and have not seen this until just now. I want you to know that my thoughts and prayers are with you and Pip. Hang in there and stay strong.

Hugs,
Heidi and Chloe

Margaret Boyle
09-22-2010, 03:18 PM
Hi Pam,

Just to let you know that Pip and you are in my thoughts and prayers.

Whatever you decide Pam will be the right decision, you know Pip better than anyone.

Do as I am doing Pam take each day as it comes, that is all we can do.

I know you will be worried about the liver biopsy but you are like me Pam I have to know, and I would not let them suffer..........hopefully it wont be bad news Pam.

Big hugs coming your way.

Margaret

pgcor
09-22-2010, 05:14 PM
Thank you for your support. It really does help. His liver values have always gone back down with an antibiotic. The problem is that the Specialist won't prescribe Baytril anymore. He's on Tylan - but it has not been effective. In one month:

AlkPhos 543 213
ALT (SGPT) 380 119
AST (SGOT) 50 53
Cholesterol 528 425

Not bad, but the Specialist feels they will get worse. Pip has had two ultrasounds and both show a thickening in his liver and in various parts of his digestive system. Since the specialist can't prescribe anything without knowing what's going on, I felt I had to do something. I am afraid for him because it's ultimately my decision, but I think the odds are good that he'll be fine and maybe we'll be able to treat whatever it is. I thought it was worth a shot.

I'm the kind of person who really acutely feels the burden of responsibility for Pip's well being and it's been hard to come to this decision.

BTW, thanks for being there for me and Pip - even though I've been absent for awhile! You are all wonderful!

Pam

CarolW
09-22-2010, 11:32 PM
Pam - I'm so glad you posted with your worries. I agree with you - all good thoughts, prayers, efforts at marshaling the forces of the Universe in Pip's (and your) favor - really do help. I've seen what I consider miracles, when people like our forum members all pull together this way.

I have some idea of what a tough decision it is to decide to go ahead with the biopsy. We just can't ever really know, ahead, what is the best thing to do. I'm sure the specialist is right that Pip can't be treated without knowing more about what is going on.

So you can indeed count on us - Kwali and Kumbi from the Bridge, Camellia and me from Earth, to pull for Pip and you. The massiveness of your love for, and empathy with Pip - has always been most evident, even if you haven't posted a lot. And you've always posted to the rest of us with you own empathy for everyone.

So, we'll be watching for your reports. I know what you mean about the shaking hands! This often happens to me, too, under such pressures.

We love you, Pip; we love you, Pam. I KNOW we're all pulling for you.

Wed, 22 Sep 2010 23:31:05 (PDT)

ladysmom06
09-23-2010, 04:49 AM
Hi Pam,

Sending tons of prayers and positive thoughts from my house to yours for you and Pip. Hugs to the two of you.

pgcor
09-23-2010, 05:52 AM
Oh, thank you all so much! I know this will help Pip - knowing you are all out there supporting us is a god send!

I will keep you posted on Pip's biopsy and recovery.

Thank you from the bottom of our hearts for making this easier!

We love all of you too! Pam and Pip

minpinlover
09-23-2010, 06:03 AM
I'll be sending thoughts and prayers for you and Pip and watching for any news. The decisions are never easy when we love our babies so much. I hope all goes well for Pip!

Patty
09-23-2010, 06:04 AM
Pam,
We are definitely thinking of you! :)

I know you've home cooked in the past. What are you currently feeding Pip?

Patty