Mandy: diabetes plus kidney, heart failure, now blind

[foxandhound]

Hello,

My dog Mandy is pretty sick, but she is in good spirits for now. She has many more good days than bad, but she is progressively getting worse and today she woke up pretty blind.

We adopted her with a murmur and hypothyroidism at age 8-9. She was active, happy, enjoying life, eating a raw diet, and getting thyroid meds. She began slowing down a year ago (age 13) and lost consciousness while running/playing. Ultrasound showed heart failure/enlargement and mitral value degeneration. Ultrasound also showed multiple kidney cysts and adrenal nodules. She had no symptoms of kidney failure, but the cysts were present. She also seems to have asymptomatic Cushings. By that I mean, she did not have polydispsia/polyuria symptoms, but she does have a voracious appetite, nodules on her adrenal glands, very, very high ALK levels, and positive ACTH. Two different vet specialists decided not to treat for Cushings because she still had a very good quality of life and did not have symptoms to warrant treatment.

Everything was smooth sailing for a while. She was on Vetmedin for her heart, Lasix for her congestion, and Enalapril for her proteinuria (she did not have high blood pressure, this was prescribed due to her high protein loss in her urine). She loved food and shorter walks, things slowed down, but she was happy and pretty well. We did this for about a year and eventually, the Enalapril and Lasix destroyed her kidneys because her BUN and Creatinine started to show problems, she started vomitting, etc. Specialist ordered us to stop giving Enalapril and Lasix, we started a probiotic supplement called Azodyl. She was so much better!!!

A few months later, she became very ill again and this time, her BUN, Creatinine, Phosphate, and Glucose levels were sky high out of nowhere. Her kidney disease went into hyperdrive and she developed diabetes overnight it seemed. We did emergency IV fluids and started Insulin. How did she become diabetic at this stage? Have you guys heard of this??

So, that brings us up to date. She has been on the Insulin for a couple weeks. She was on 5 units, twice a day. During this time, I was reading a lot and I realized no one put her on a phosphate binder for her high phosphate levels. What a disaster! I got her started on Aluminum gel. The Insulin doseage was checked. She was doing so well again!!! Better than in a long time!!!!

BUT Today, she woke up pretty blind, not completely, but drastically. She is NOT a candidate for any type of surgery, she is very high risk. What to do??

We will go back to our Vet tomorrow, recheck kidney and glucose levels, maybe get drops to reduce pressure in her eyes. Any ideas about eye drops???? She still loves food, treats, petting, snuggling, etc. I am without a job right now, so this has been so hard for us emotionally and financially. Her vet visits, medications, and homemade diet is hard for me to now keep up with. I am saying this because I feel very guilty, but I cant afford an eye specialist. Maybe a few months ago, but not now.

I am assuming the diabetes has maybe resulted in blindness and/or glaucoma. Is this vision problem permanent? If it is glucose related, will the proper insulin doseage and/or eye drops help restore vision? I need to know and mentally/emotionally prepare myself for this. The best thing I can tell you is Mandy seems to be in good spirits, enjoying food, treats, and petting.

-Annie (Mandy, beagle, 27lbs, heart failure, stage II/III renal failure, newly diabetic, sudden vision loss)

[jjefferjo]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Welcome you have been through a lot and a ways to go - lots to process
Take big deep breath and hold on.
So lets start with
Mandy's weight
Diet type and quantity
Are you home testing? if not I would encourage it - just to save $$ alone
Dogs adapt to blindness - every dog is different - we as humans not so much

My Ed has Glaucoma and is surving on drops every 12 hrs- permanent? yes

One of the moderators will be along to help - you have found one of the best places to be - rid your self of the guilt it wil impeded everything you are trying to do to save Mandy.
Right now Dog Diabetes is what it is
Welcome

[k9diabetes]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Hi Annie,

Unfortunately, diabetes-induced cataracts are extremely common. The high blood sugar causes changes in the lens, and it's a lucky dog who doesn't develop cataracts once they have diabetes.

I'm oversimplifying, but essentially the lens breaks down and it cannot be repaired. The only treatment for diabetes-induced cataracts is to have them surgically removed.

The good news is that most dogs adjust well to blindness and learn to find their way around and resume nearly the same quality of life as they had before.

Our dog Chris was blind for his last four years - he was a larger dog, 65 pounds, and lived to be 14.5 years of age, dying of cancer, not diabetes or anything related to it. So most of the five years he had diabetes he was also blind.

And, by coincidence, he too had pretty significant heart problems. He was sensitive to Lasix so couldn't take it, but the Vetmedin was very helpful for him.

I hope for Mandy it is only cataracts, not glaucoma. There is a pretty good anti-inflammatory, nonsteroid eye drop called flurbiprofen that generally works well to keep inflammation from the cataracts at bay and they are not very expensive.

You want to avoid any drops containing steroids as they often raise blood sugar even when given only as eye drops.

I hope your vet can either prescribe it directly or consult with an ophthalmologist and get her on some drops to keep her eyes healthy.

It's somewhat common for a dog with Cushing's to wind up with diabetes and vice-versa.

Dogs are akin to Type 1 human diabetics in that there is an auto-immune attack on the pancreas that kills the insulin-producing cells. Could be this is due in part to her untreated Cushing's disease, as dogs given oral steroids can develop diabetes.

Mandy has a lot going on... we were very much in the same spot as you with our diabetic dog his last two or three years, only we did the diabetes first and then the other stuff followed after. We managed what we could and lived with the rest and just kept an eye toward quality of life.

Given that Mandy seems happy and in good spirits, she must be quite a resilient dog and I suspect she will take the blindness in stride.

Though it seems like it came on suddenly, probably her vision has been declining for a few weeks at least and it just now got to the point where she couldn't compensate. So she probably has had some time to adjust that you haven't.

Hang in there.

Natalie

[foxandhound]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Hi, thanks so much guys.

I don't test at home. I have no clue how to do so. Can someone help me with that? Can I buy a kit at Walgreens/CVS/Walmart? Do I do the test before/after her doseage? Are there instructions to increase insulin accoridng to the glucose curve thing? :X So much to process. Sorry for all the questions, Im a little nervous. Mandy's vision loss seems more sudden than anything, she is lost without my voice, bumping into everything, walking into walls. Im so sad. Did this happen because I dont test at home???

How would we distinguish glaucoma from cataracts?

So sorry to hear about your Chris, but thankful to have his and your help.

Yes, I think Mandy's untreated Cushings caused further progression of her kidney and heart problems, and probably now destroyed her insulin producing cells. I read something about this somewhere, cant place it. I never knew if it was or wasnt a good idea not to treat. I am a member of k9 cushings and was also told that Mandy didnt have the symptoms to treat. I always blame myself, not having the answers.

When Mandy developed severe proteinuria as well as confusion, anorexia, vomitting from even moderate protein amounts, I had to change her diet. So, we moved away from raw and I started homecooking meals and adding grains. Her appetite is all over the place...voracious to not at all, depending on her BUN/Creatinine. It's hard with advanced kidney disease. We are in our final weeks-months here and there's still quality to her life, but small periods of confusion, depression, anorexia when her kidney values creep up.

The amount that Mandy eats varies because of her kidney disease. Maybe 30% grain, 25% protein, 20% fat, 25% veggies. She eats whole grains (brown rice, pasta), egg whites, fewer egg yolks, chicken fat, beef fat, brocolli, green beans, etc. She also gets small portions of meats, which she loves, but I have to keep it in moderation because it's not as easy for her system.

[Shellie]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Hi Annie! Welcome to you and Mandy! I'm very glad that you found us here and know we'll be able to help answer a lot of your questions.

First off...don't blame yourself for any of this. It happens regardless of what we do. My pup, Hank, started out with very mild cataracts which are worsening rapidly. He's likely at about three quartes sight now. I am sure that he'll be fully blind by the end of the summer at the latest. I tore myself up at the beginning thinking of him going blind and as it happens, it still bothers me terribly. But, as Natalie said, the dogs don't feel quite the same we do. I always say that the dogs probably just think, 'hrm, who turned out the lights? Ok...it's dark!" and just keep going.

We have a number of dogs here who have lost their sight and there are tricks to keep them happier in that respect. Keep the paths that Mandy uses in the house free of stuff. Try to make sure what she does bump into is soft or blunt edges of things until she learns her way around. Talk to her a lot as you go about your daily tasks so she knows where you are. One parent here actually wore flip flops so his dog would always know where he was. The easier you can make things for Mandy to get around, the easier she will transition. I've already given thought to how I will handle the stairs he uses to get into bed and onto the sofa...planning on putting sides on them. Little things like that can help them so much.

For home testing, most of us use the OneTouchUltra which is a human meter. You can get one at most pharmacies or at Walmart. The best price on strips can be had at Amazon where you just need to keep an eye on exp dates. It's a good idea to take it with you for some comparisons with the vet's office just so you can make a basic conversion between the two. Mostly with the OneTouch...it is really close in the lower ranges but over 400 or so it gets about a 100 points or so off. But realistically, if it's that high...a few points either way isn't going to matter much.

http://www.k9diabetes.com/bgtestvideos.html This is where you will find some great videos of home blood testing that some folks here have made. Carol's www.coherentdog.com (I am pretty sure that's it!) has a ton of other material as well. Home testing can be very easy once you and your dog get used to it. We always suggest doing 'dry runs' where you do everything to the dog except stick the needle in. They get used to the equipment and all the procedures before you ever have to do anything that way.

I know this seems so very overwhelming especially with all the other medical issues you already have to deal with. It does get easier! And you'll get more used to the idea of Mandy being blind. We all go thru a helpless, frustrated phase now and again and will be here when you need support. This can be managed and with some help, you CAN do it!

Please let us know what you have questions about or if you need anything! Hugs and take care!

[JayneN]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Hello Annie & Mandy...

nothing to add, most has been covered in the last several posts, but wanted to say welcome, relax and people here are so nice, they will help you as much as possible. {{hugs}}

[foxandhound]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Hi, thank you so much. It means a lot to us. I am really trying to hold it together, but much of the day was spent crying. Im a mess. What percentage of diabetic dogs go blind would you guess? Does it also happen to dogs who are well controlled on insulin? I am so sad, Mandy seems sad/confused. This is tough stuff for sure. Thanks everyone for helping us through this.

Glaucoma vs. Cataracts? Can a regular DVM weigh in?

Can I buy theO netouchultra, the Strips, and the pin prick thing all at walmart? Do I need a prescription? What about the One Touch Mini???

So, when/if her tests come back in the 200-400+ range, by how much do I increase insulin, gradually in steps?

[CarolW]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

I think your regular vet can test eye pressure; not sure - you might ask! That would be what you want to watch out for; I think it would reveal glaucoma. But ask your vet. Maybe Natalie can tell us, too.

Don't get the OneTouch Mini - it has no resemblance to the OneTouch Ultra2, being much smaller, and many fewer features, and I also found it more difficult to use than the Onetouch Ultra2. The OneTouch Ultra2 has a reputation (well-deserved, I believe) for being consistent and reliable; I used this meter with Kumbi for years.

Not using it now because he died - of cancer, not diabetes.

Kumbi was blind, too, and adapted very well after a few weeks; Mandy might do the same. I'm glad you're on the k9cushings forum - great forum; so is this one!

A Big, Fat Welcome to you and Mandy! (going back to bed!)

Wed, 18 Apr 2012 01:02:09 (PDT)

[Sadie's Mom]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Hi Annie,
Wow.. A lot going on with Mandy!! My Sadie was diagnosed with mitral valve prolapse last April but no meds needed yet. In August she was diagnosed with diabetes and went blind about a week later. She seemed a little disoriented at first ( maybe it was more my imagination but she adjusted quickly. Just cautious when she walks, and I talk a lot to her. If I see she is going to bump into something I let her know. When I miss it she really walks around using her nose so it is a light tap that doesn't hurt her and she just backs up and starts again. We just went for another ultrasound yesterday and she did great. I myself was very nervous. It took me awhile to get used to testing at home, but definitely worth it when trying to regulate. You have gotten a lot of great advice already. You also have a lot going on. My best advice is to educate yourself as much as possible, ask questions and take one day at a time. welcome to you and Mandy!

Debbie

[spiritdog6]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

You might want to have her BP checked as well. It should be a cheap ($18-$30 depending on the vet). Simple test, just like human BP testing.

I did have a dog that went blind over night, and found the cause to be super high BP (over 300). Just like in humans, you can't "see" high BP.

I also had a cat go blind from high BP, lucky me eh So I am a HUGE advocate of animals having their BP checked at least once a year.

Did Mandys eyes go bluish, like you can see the cataracts?

Just throwing this out there as an option, I hope I didn't worry you more

My present dog did go blind from diabetic cataracts, it took about 5 weeks developing, and on a walk boom the curtain dropped and he was totally blind. I know the heartache it is crushing, at least it was for me.

[eileen]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

I'm sorry to read of Mandy's health issues.

I wanted to comment that one of my crf/heart issues kitties became deaf from her use of Furosamide, in reading I know that blindness can also be one of those rare side effects.

Sending positive vibes your way...

[foxandhound]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Thank you everyone! It means so much to us. Our family was lost without you guys.
We were not able to be seen today and the vet wanted us to physically come in for eyedrops. So, tomorrow it is.

Mandy is already adjusting a bit to her blindness. We are not. lol. Guess it will take a while. She seems frustrated at times and I take it tragically.

I have to give Mandy many pills about 30-45 mins prior to her meals, this includes wrapping them in peanut butter, some days in pill pockets, and other days in dog food. I have to vary the method for the days that she is not feeling as well.

I guess this pill delivery elevates her glucose level, but is it ok??

Also, I noticed Mandy does better on 3 meals per day, seems to be easier on her kidneys (she is stage II-III kidney failure). Can feeding 3 meals per day be ok??? Would insulin still be 12h apart? Can it be less than 12 hours apart?

I think Mandy may have weeks to months here since we are dealing with multiple organ failure...just wanted to get an idea of how important it is to avoid treats throughout the day? She loves treats and yummies, my family thinks it might not make sense to be so strict in her last days? What should I do?

[jesse girl]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

i think you can do most any routine and if you can have blood sugar that is not out of control and mandy seems comfortable it should be fine my jesse is on one meal a day some have 4 meals a day so there is flexibility

whatever you decide to do is try it if your comfortable with that then try to stay consistent or as much as she will allow you to

[eileen]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

I think Mandy may have weeks to months here since we are dealing with multiple organ failure...just wanted to get an idea of how important it is to avoid treats throughout the day? She loves treats and yummies, my family thinks it might not make sense to be so strict in her last days? What should I do?

I'm so sorry.

When my girl was in her final months/weeks I no longer worried over trying to keep her glucose levels 'perfect'.
I fed her when she wanted and what she wanted (within reason) and did the best I could with her diabetes considering it all.

If you think your girl if facing the end I agree with your family, let her snack on what she enjoys...let her be a happy dog.
Do the best you can with keeping her glucose from going sky high, and understand that it will not be the diabetes that takes her life...it very seldom is.

My heart goes out to you and your family.

[heinzle]

Re: Mandy: Sudden onset diabetes in addition to kidney and heart failure, now blind??

Also, I noticed Mandy does better on 3 meals per day, seems to be easier on her kidneys (she is stage II-III kidney failure). Can feeding 3 meals per day be ok??? Would insulin still be 12h apart? Can it be less than 12 hours apart?

I think Mandy may have weeks to months here since we are dealing with multiple organ failure...just wanted to get an idea of how important it is to avoid treats throughout the day? She loves treats and yummies, my family thinks it might not make sense to be so strict in her last days? What should I do?

Not only is 3 meals per day okay I read a few vet articles that recommended it! I actually feed my girl 4x per day splitting her morning and evening meals 2 hours apart and giving her shot during the 2nd part of each meal.

You know your Mandy better than anybody - I believe you need to listen to your heart and instincts.

Sorry to hear about all the troubles you're going through. Mandy sounds sweet.