Mik is gone...

[robertpri]

It appeared Mik had cushings but we should know Monday if it's diabetes. I have read a great deal on this site, and one aspect is maintaining a firm schedule for meals and insulin. This makes sense, of course, but it will take some adjustment.

Wife had serious health problems and could not rise and get going physically until about 10 am. She had them fully trained to not eat until 11 am, and again around 6.

The diabetes has played havoc with Mik's schedule, except in the am. Wife did a fine job because neither Mik or his brother Mak will even get up before 10, and not ready to eat until 11. Their body clocks are set.

I have to be gone 3x a week from 6 am to about noon, so I come home and they are ready to eat.

But tips on this site indicate meals and insulin should be 12 hours apart. There is nothing I can do about the necessity of my morning demands, so should I try for their meals around noon and midnight? Obviously, if essential, I will find a way. But they are usually zonked by 8 or so.

But is that 12 hour guide set in stone? I could manage around noon at 10 pm, but that's 14 and 10 hours. How critical is the 12 hours?

Sorry for the long post, but i want to do this right.

many thanks to all and I"m grateful to be here.

[BaileyBear]

Hello & Welcome! :)

I was told 12 hours apart, with up to an hour wiggle room in either direction. But some of it depends on your dog and how their body reacts to their food/insulin/activity combo once they are regulated. Some dogs need to be fed/injected on a very tight schedule or there will be too many wide variances in their BG readings.

The good things is that the 12 hour window can be anytime that works for you. My vet says he has a dog with an owner who feeds/injects at noon & midnight because that's the only schedule that consistently works for her and her dog does great. I personally use a 10:30 am/pm schedule because my mornings are flexible, but I'm often out in the afternoon/evening and worry about getting home in time. We may even move to a noon/midnight schedule ourselves this summer since we are usually out later then.

I know it seems like the dogs will have a problem adjusting to a new schedule, but you'd be surprised how fast they get used to it and their body clock re-sets. They may pester you in the beginning, but then their bodies get used to it - especially if you stick as close as you can to the schedule and routine. My dog used to be a free-feeder so he was used to having food available any time he felt like it. Now he actually thrives on the new routine and his little internal clock starts going off by about 10:15, the time I generally head to the kitchen to get things ready. If I'm involved in something else, he is all too happy to remind me, lol. :D

Maybe you could try feeding/injecting around 5:30am/pm, so that you could do it before you leave and then their evening meal would still be around their normal time. Once you have used the routine for a while and Mik's BG readings are in a reasonable range, you could try adding some low glycemic veggies to the routine as a snack/treat when you get home around noon, so they're still getting something that they associate with your return home. :)

I'm very sorry to hear of your wife's health issues and hope she is doing better. It sounds like you have a lot on your plate with a sick wife and a sick dog. I'm glad you found your way here for support and look forward to learning more about Mik. My parent's had a Shih-Tzu and she was so darn adorable. They sure are cute little dogs. :D

[k9diabetes]

Hi Robert,

Glad to see you here!

Erin's advice about the schedule is right on. You can pick pretty much anything that works for you and if there needs to be slight variation from the straight 12 hours some days that's usually manageable. I wouldn't go to a 10/14 hour schedule unless you have to as that could wind up giving you some problems.

Kind of depends on if you're a morning person or a night owl!

Could feed every day at 5:30 am and 5:30pm, which would come close to your the evening meal your wife set up before she passed away.

Or if you like late nights better, you could do something like 11:30am or noon and 11:30pm and be a little late with the noon meal on the days you have to be away all morning.

For those just meeting Robert and Mik and Mak, here's a link to the thread on the Cushings forum where you will find a bit more history...

http://www.caninecushings.net/forums/showthread.php?t=8807

How is Mik feeling today?

Natalie

[robertpri]

Many thanks, Erin & Bailey

No way for you to know, but wife died five months ago which triggered a lot of emotional problems in both dogs [and me!]

The three were constant companions, and for months, Mik and Mak would wander the entire house looking for her. They were confused and depressed. Mik would sit for hours on the floor near wife's side of the bed, convinced she was there, and he just waited for her to get up.

Heartbreaking to watch.

They were always happy, playful dogs, curious and chasing each other.

No matter how much time I spend with them, they have little interest in anything. I didn't post their history here, but it's been pneumonia, congential heart condition, months of hacking and coughing, seizures, trips to all night Vet ER's, blindness, and doing poorly in general.

Mik went blind in a matter of days, and that adds to his confusion. He has not learned to memorize things and bumps into everything.

Our wonderful vet has examined them many times over the past 5 months and has given me the "quality of life" speech. Lots of love and comfort.

My kitchen looks like a mini-pharmacy with post-its on which dog gets what and when.

6am/6pm would work for me and the insulin, but in 13 years, we have never got Mik to eat in the morning With the diabetes, it seems quite impossible. He has zero interest in anything but water until noon or after. I am sure he needs food with the insulin.

Correct?

Perhaps I can find something that he will eat that early. I will know more monday am with the vet.

[k9diabetes]

We were posting at the same time Robert... as far as the a.m. not wanting to eat, we see a lot of this in dogs. Talk it over with the vet as diet is a big part of diabetes and his picking eating means he probably should not be switched to a prescription food unless he absolutely loves it.

If once you get going Mik just refuses to eat on that schedule, we will just have to get creative about how to deal with it.

But one day at a time - I say cross that bridge when you come to it just in case you luck out and you don't! :)

Natalie

[robertpri]

Thank you, Natalie, I guess our posts hit at the same time.

I will have to figure something for the schedule. I have to leave for a part time job around 6 am. At 69, I should not be doing that, and my own heart doc agrees.

Luckliy, I'm not one of the home foreclosure victims but like so many others, suffered a gigantic pension and 401k loss. Retirement package and recent medical bills took a major hit. I'm NOT whining here, and consider myself blessed, but leaving my little guys alone is a necessity, and not a choice.

thanks for all your help, and I'm reading many threads here to learn more.

[We Hope]

Robert,

You'll find something that works for you! ;) We have a quite a few people here who aren't at home all day and no one in their household is either. They manage to find a routine that works out fine for both them and their dog with diabetes.


Kathy

[robertpri]

Robert,

You'll find something that works for you! ;)


Kathy

Yes, I will. Thanks. Back to vet on Monday for the details.

[robertpri]

I noticed something this am. Mik is weak, and he rarely eats more than a 1/4 cup of anything at once. So, to get food into him, I have to feed him several times a day, which I know is not good. But he needs to gain wt.

I saw that his front legs beging to tremble from the effort of leaning over to eat. Seconds after the trembling, he loses interest and walks away.

I wonder if his leg weakness\trembling is affecting his appetite?

[We Hope]

Robert,

The thing when starting insulin is to get them to eat enough to be able to get their full insulin doses. If it's not good "diabetic food", I wouldn't worry about that right now; get Mik eating regularly first.

Many don't want to eat when their bg's are too high, just as it can be a problem getting something into them when they're too low and you also need to.

Mik may be weak right now and he also may have a problem called neuropathy if his bg's have been high and stayed there for a while. Neuropathy is a problem with the nerves and muscles communicating properly to allow you to do normal things like standing and walking with little to no effort.

These things get better most of the time a while after the dogs get on enough insulin; they also re-gain any lost weight when they're getting regulated.

Do you check his urine with ketodiastix to make sure Mik has no ketones? Ketones can be an emergency situation.

Kathy

[robertpri]

Robert,

[snip]
Do you check his urine with ketodiastix to make sure Mik has no ketones? Ketones can be an emergency situation.

Kathy

I bought the test strips this am, and read the instructions. First line was to ensure they are not expired. The box is end date was 1/2009, so took them back. Just got new ones and will test.

Of course, Mik has been urinating all over the house--until now. He has decided to hold it. [heh, I can't out think him]

[peggy0]

Hi Robert,

I'm so sorry for your loss and the situation with your pups. I lost my mom and sister within 6 months of each other last year and then Forbin developed Diabetes. Anything we can all do to support you with Mik, we will do. This is a wonderful group of people and kathy and Natalie are wonderful in providing the info you will need. You can never ask too many questions here.

I'd check ketones as well and if there are no signs, I'd feed him anything you can get down him. Have you tried boiled chicken with a bit of kibble? You can even add a bit of the water from boiling the chicken to make the hard food more palatable for him.

[robertpri]

Thanks, Peggy0,

Mik and I are struggling through his continually shifting preferences, Waiting for the big event to test ketones

[robertpri]

Another odd one. At times, Mik goes for this water bowl and just whimpers and cries. He dips his mouth into the water, gets wet, but it seems that he cannot drink.

Almost like he forgot how, or something wrong with his mouth.

I pick him up and hold him, try to get his mouth open [which he really hates] than usually within a few minutes is able to drink water.

I have never seen this before.

First keton reading was moderate, about 40, but it keeps getting slightly darker after the 15 seconds. Maybe to 60. The instructions say "exactly 15 seconds." He sees the vet first thing in the am.

[We Hope]

You really need to speak to your vet tonight. Mik needs to see someone tonight because you can't let the moderate ketones go; they may be more serious by morning.

Mik may be dehydrating from having the ketones. You need to call your vet and talk about how to treat him now. If your vet isn't available, I'd suggest contacting an ER.

Kathy

[robertpri]

will do-thanks

[We Hope]

Robert,

Please let us know!

Kathy

[eyelostit]

Robert,

I hope Mik is OK,
Welcome to the board ! Niki and I are late feeders

[BaileyBear]

Robert, I'm so sorry to hear about your wife's passing and everything you and your pups have been through. I had no idea when I originally posted. :o

Ketones are an emergency situation. I hope you were able to get in tough with your vet or take Mik to an emergency hospital and that he is OK. Hang in there and let us know how he (and you!) are doing when you get a chance.

Holding you and your pups in my thoughts.

[k9diabetes]

Robert I see that you are here now... how is Mik?

It looks like you are not too far outside my neighborhood... you'll have to let me know who your vet and clinics are so I can put them in my database of local vets.

So glad you got the strips and checked on him as I didn't like what I was reading about him. I hope they got him started on some insulin tonight.

Natalie

[angelbudsmama]

Hi Robert...We have not "met" yet....Just wanted to say welcome, and that you are in my thoughts as you navigate through this situation with Mik! I read your posts...hoping that insulin got going tonight, and if you were able, some fluids at an ER facility to flush those ketones out....

One of my best friends, Michelle has two Shih-Tzu's..and they are DEF. picky eaters. They won't eat anything in the mornings. Managing a diabetic pup in that scenario makes it doubly hard. Hang in there!

Once you get your routine going, there are lots of goodies that are legal that you can put on Mik's food to get that appetite going! Over the years, I have tried them all! (: As far as the 12 hr schedule goes, my vet in the beginning was pretty insistent that you try to follow the 12 hour rule. Once things get regulated and figured out, I was advised an hour window was okay either way. But, you really need to first see how Mik processes the insulin before you adjust your timing too much.

I know this is all so overwhelming, but please know we all are/have been in this big diabetic boat together, and we won't let you go under...we will figure it out. I am sorry for the loss of your wife...she sounded like a lovely woman who cared for your dogs deeply.

Blessings,
Judy in Arizona ( mom to my Angel Bud ( rat terrier, 6 years diabetic, 13 yrs old, passed on Feb. 17) and Harley ( my sweet Aussie/retriever mix)

[Margaret Boyle]

Another odd one. At times, Mik goes for this water bowl and just whimpers and cries. He dips his mouth into the water, gets wet, but it seems that he cannot drink.

Almost like he forgot how, or something wrong with his mouth.

I pick him up and hold him, try to get his mouth open [which he really hates] than usually within a few minutes is able to drink water.

I have never seen this before.

First keton reading was moderate, about 40, but it keeps getting slightly darker after the 15 seconds. Maybe to 60. The instructions say "exactly 15 seconds." He sees the vet first thing in the am.


Hallo Robert and welcome I have been reading about the problems you are having with your pup, you have came to the right place you will get all the support you need they are a great team and know their stuff.
I am sorry to hear about your wife Robert this must be very difficult for you.
They will all help you with your wee pup.
I am quite new myself so I know how you feel.

LOL

[robertpri]

It's been a busy night and morning. Last night, Mik's ketone test strip was moderate. Got to vet and he began insulin--"Vetsulin" at 5mg. [1 mg/kb + 1 =4+1]

Vet tests show high glucose but like links on this forum, does not want me to adjust insulin based on glucose test strips. He wants me to monitor water consumption and ketone tests.

I guess glutose test strips can have 'spill over' which affects readings.

Vetsulin is used once a day, unless treatment is ineffective, then adjust to twice a day with about 70% each time, or 4 mg 2x/day

Vet was not overly concerned with diet at this minute, getting whatever food Mik will eat. He also explained maple syrup or sugar water if insulin is too much. He said overly lythargic, dizzy, confused and falling over might be a sign to use sugar water.

I am reading everything I can on Vetsulin.

Complicating this, his brother Mak went into some kind of reaction to his heart medicine so that was another two trips to vet to adjust his meds.

Busy 12 hours.

[k9diabetes]

Hi Robert,

How much does Mik weigh?

Insulin is usually measured in units of insulin -- perhaps it's 5 units. Are you to fill the syringe to the 5 mark?

Natalie

[We Hope]

Robert,

The business with the urine strip testing, unless you need to look for just ketones, is that what you see in urine is basically a "delayed report"; this is the amount of glucose you would have seen in the blood 2+ hours before. (There is a meter which tests blood for them, but the strips are VERY expensive-close to $50 for a pack of 8.)

When you get to 180 mg/dl and stay at that reading or above for a while, the glucose starts to spill into the urine; it's called the renal threshold. If there are no times when the bg's have been at or above 180 and remained there for a time, you will simply get a negative on the glucose reading. Getting a negative tells you the dog is reading somewhere under 180 and that can be a big "somewhere". It can't tell you whether he/she is too low. Testing blood can tell you that and it also provides information about how much glucose is in the blood right now--not 2 + hours ago.

And now to Vetsulin. Vetsulin is an intermediate-acting insulin, just as the human NPH you've seen written about on this board is. It's not a long-acting one shot a day insulin, but needs to be given twice a day.

Otherwise, you're trying to "stretch" it and here's how. With the one shot a day plan, you give all of the insulin in the morning, after breakfast. Then you need to give an larger meal 6-8 hours after you've given breakfast and the insulin shot.

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

Dogs administered insulin once daily

"The first meal (e.g. 1/4-1/3 of the daily ration) is given prior to the morning insulin injection. This allows the owner to see that the dog is feeling well and eating normally before the insulin is administered.

"The second meal (the remainder of the daily ration) is usually given about 6-8 hours later."

What you're attempting to do with the second, larger meal is to have it start digesting before the insulin "peaks", or is working the hardest. If this doesn't happen, you run a very big risk for having a serious hypo because there's a lot more insulin in the system than there is food to handle it.

When I was on another board, every one I knew who had tried the once a day insulin regimen had to switch to twice daily to get their dogs regulated. One friend in Belgium, tried for 7 months to get her dog regulated; she failed until the insulin dose was split and given 12 hours apart, after breakfast and after dinner. I lost track of how many times there was a rush to the vet or ER because he was in a serious hypo. After splitting the dose, he regulated very easily and quickly.

My Lucky was the first US Vetsulin patient who had not been involved in an earlier trial. At the time we needed it, Vetsulin had not yet been approved for use in the US, so we had to file paperwork with FDA to gain permission to import it for him.

Lucky was resistant to both human and beef insulin; only a perfect match to a dog's own insulin, which is pork insulin, was effective for him. He initially regulated on Lilly's Iletin II Lente, which is the same type of insulin as Vetsulin. The difference here is in the strength of the two. Lucky took two shots of that a day, just as he did with the human and beef insulins which did nothing about lowering his blood glucose.

When Lilly discontinued Iletin II Lente and Lucky had intolerances to the suspension and preservatives in Iletin II NPH (pork NPH, which they still made at the time), the only hope to help Lucky was to get him back on pork Lente insulin. We made no secret of the fact that we intended to use the Vetsulin/Caninsulin just as we did the old Lilly pork Lente--by body weight and twice a day.

Lucky was about Mik's age when he was diagnosed with diabetes and he could give you an 85 mg/dl between 8-10 hours after breakfast and morning insulin. He never had a hypo and was able to keep wonderful control on his twice daily Vetsulin.

I believe you'd do much better with the twice daily insulin. How much does Mik weigh? Lucky weighed 9.5 lb and 4 IU twice daily was the dose that kept his bg's so well in control.

Kathy

[robertpri]

I fully understand a twice a day regiment, but it's impossible to get Mik to eat anything in the morning. He is not a gobbler, but a picky eater, one lick at a time. Always been that way, and now with diabetes, I must get some wt on him but he will not eat.

I have tried dry, vet approved can, kibble, baby food, a/d prescription food, boiled chicken, etc. In the am, he will just walk away. Around 11 is the first interest of any kind with food. He has been this way for years.

This was one reason the vet chose Vetsulin because of the one\day dosage. Of course, I don't disagree with anyone on this board--you people are the PHD's, and I'm in the first grade.

But I also know that Mik will not eat in the early am, and I cannot give him insulin on an empty stomach. My choices seem to be one/day, twice/day, but reading the steps on the link you provided [and came with the insulin] both suggest the early meal.

I can manage the insulin at whatever time makes sense, but I cannot force feed mik in the am. He simply will not eat, never has, and does not appear likely to change.

So, I dare not inject him in the am on an empty stomach.

Second option appear to be a meal + injection around noon-1. But that pops the other problem, Mik is zonked out by 9. I have never tried to wake him at midnight for a meal. I can do that, but can't know the results yet.

I have other questions about testing, but will put them into my next reply. many thanks!

Oh, Mik weighs 10.2 pounds, and yes, it's 5 units of insulin. That much I can do.

[robertpri]

Okay, basic, grade school level. I have read countless pages on diabetes, and would just like to confirm my understanding in simple terms.

1: food contains sugar/glucose.
2: the body processes this glucose
3: when the body cannot process it properly, blood sugar goes up, patient gets sick
4: when the process is failing, we can see it with high readings on the glucose and ketone test strips.
5: inecting insulin will process the body's glucose.
6: test strip readings go down
7: if the readings do not go down enough, the insulin can be adjusted
8: if the insulin is too strong, the reverse happens and the body is glucose starved [hypo]
9: if that happens, maple syrup [vet's suggestion] will elevate the glucose but if bad enough [coma] trip to ER

Am I close? I am trying to understand the basics

[We Hope]

Robert,

I have seen people who have needed to deal with diabetes for themselves or for a family member on two or four feet, who didn't "get it" as well as you do! :D

Kathy

[k9diabetes]

Hi Robert,

I am concerned that the starting dose of insulin is quite high.

They often do this when trying Vetsulin once a day but wishing and hoping that he will get a slow delivery of the insulin over 24 hours doesn't make it so and, as a result, that high starting dose can be just plain too much insulin in the first few hours after injection.

Until the insulin brings his blood sugar down some, he may be able to tolerate that large dose but after a few days there is a good possibility it will be too much.

My dog was one who was very sensitive to insulin. At 60 pounds, he never needed more than about 12 units per injection.

I don't like to see them start with more than 1/4 unit per pound, which in this case would be 2.5 units.

Which means Mik will need very careful monitoring of his blood sugar. I would test his urine with the ketodiastix several times a day and if his urine tests drop rapidly down to moderate to trace glucose only in the six to eight hours after his injection, you need to contact the vet immediately about reducing his insulin dose.

I know you have had a lot to absorb in a few days but...

Please consider home blood glucose testing. There are video and picture tutorials here: www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html). A small dog like Mik is probably easiest tested on the back at the base of the tale but I have also seen small dogs tested on the lip. With Mik, I'd recommend a Freestyle meter to start.

[k9diabetes]

As for the eating and injection schedule, there's no harm in trying once a day and see what you get - but he will need very careful monitoring.

Just know that, in my experience, 98% of dogs will need two injections a day to regulate their blood sugar.

However, there is another option that not many vets consider...

Most dogs can have 1/4 to 1/2 their insulin dose if they do not eat. This is insulin that is needed for the "basal" need for glucose - the insulin that keeps glucose going into our cells when we don't eat anything.

So one alternative if a dog just flat out refuses to eat twice a day is to give a normal dose of insulin with a meal, say at 11am as Mik is used to. And then, 12 hours, later you can give 1/4 - 1/2 the usual dose and no food.

I have seen this done with a couple of dogs and I could routinely give my dog 1/3 of his insulin dose if he refused to eat, as he did in later years when he was not well.

Home blood glucose testing will allow you to monitor his reaction to 1/4 of his usual insulin dose and no food, once he's established with a With-Food dose.

So I just want you to know that there are creative ways to manage this kind of problem because there are some dogs who just won't eat in the morning no matter what you do.

I am sorry you have had such a harrowing 48 hours... you will get there and we can help you come up with some creative solutions to whatever challenges Mik presents to you. No doubt some your vet would not be familiar with!

How is Mak doing?

Natalie

[robertpri]

Many thanks, Natalie, Kathy, and Admin,

Yes, a lot to absorb. Wife use to say that she and Mik were kindred spirits, because they both ate like birds. Little nibbles here and there, just enough. That was fine, but with diabetes, it tough.

[Mak and I are the same--put it before us, and we eat it]

I knew that 5 units was too high on empty stomach, and have been watching him closely today. He is still gulping water, but the little rascal is either hiding his urniation in another room or holding it.

I am armed with test strips and following him around.

I am sort of planning to reverse the process a bit, worried about his miniscule meal in the am, and that I must go for my p/t job 3 times a week.

I fully realize that scheduled regiment and routine are critical, and will pursue that. But for the short term, while monitoring, I was planning on seeing what he will consume for the am meal, and adjust insulin accordingly.

I have zero chance of him eating a full meal in the am, so if it's a quarter, then about a quarter of the insulin, or about 1 unit.

That way, while gone, I should not worry about hypo.

At home, give him the larger meal 2-4 or so, and the "balance" of the daily insulin.

Does that sound at all practical? Or dreaming?

BTW: at 4:45 pm, Mik decided he was finally hungry, and ate a full jar of baby food and about 9 crumbled vitabones.

[vet said if nothing else, vitabone are not enough, but healthy for the short term]

[k9diabetes]

It's possible to do it that way... what makes it difficult at this point is we don't yet have any information on how Mik will handle the insulin, with or without food.

I like the idea of giving him 1 unit with breakfast if he eats anything and no insulin in the morning if he doesn't and then giving him some amount of insulin in the afternoon with dinner.

I still worry that 5 units is too much to start with... I'd feel more comfortable with no more than 3 units until you know more about how it will affecthim.

In the short-term, given the ketones, there is a need to get his blood sugar down fast. But not too fast as that's dangerous. And after a day or two, it could be too much even with a full meal.

You could simply stick with one meal and injection a day for now and see how it goes.

Most likely you will see better blood sugar in the 8-10 hours after injection and then the blood sugar rising as the insulin wears off after that time. So you would see less glucose 4-6 hours after a once-a-day injection and then a lot more glucose in the urine 14-23 hours after that one injection a day.

[robertpri]

It has been 9 hours since the 5 unit insulin. I have searched this old house for puddles or wet carpet to test. Nothing.

As usual, Mik is messing with me...

Before this, he was very regular in his "place" but with drinking all the water, he cannot seem to control urinating.

Until today

Yes, I feel comfortable with the 1 ut in the am, then testing if possible and more in the pm

[robertpri]

Finally, 10 hours after 5 units

ketones--trace, very close to negative [15 seconds]
glucose --1000 mg/dl [30 seconds]

So, ketones look good, but glucose high/bad?

Means....?

[We Hope]

Robert,

I would say you have a very encouraging sign there that the ketones have come down from last night's moderate to tonight's trace/almost gone. I don't recall that you'd given us a glucose reading last night (and to be honest, we were all concentrating on the ketones because of what they can do). Last night, Mik's glucose must have been higher than what you read tonight.

You bet we'd like to see better numbers than this, but hang on, because we will. Insulin takes some time to show its full effect. You may not see the full effect of the insulin on Mik's bg's for 2-3 days or more. You'll see things improving, just as you did with the difference in the ketones from last night to now, but the full effect of that insulin on Mik's bg's will probably take a little longer.

When you inject insulin under your skin, it's called an insulin depot. You can think of it like you would a gas tank of your car because like the engine, when the body needs it, it draws from this "tank". Mik just started filling his up less than 12 hours ago.

When you've been using insulin regularly for a while and you do something like forget a shot or if you have an accident where you get part of the shot to the pet or even where all the insulin winds up in the fur instead of under the skin, it's this "tank" that keep you from needing to re-regulate. For a couple days after that, you'll be getting higher than normal numbers, but that "tank" or depot is what keeps you from running into bigger trouble if and when something like this happens.

I would believe Mik has had his bg's come down since his shot because he's eating and you're not finding anywhere he's had an accident in the house. As his bg's continue coming down, you will see that he needs to drink and "go" less.

So while we are still fighting the bg "war", you have had a victory! :D

Kathy

[robertpri]

Many thanks, Kathy.

I did not have the glucose reading last night because I bought the correct strips, but when I came home noted they were out of date. Took them back and they handed me another box. It was later when I noticed this version did not have glucose. Returned today, so these are my first glucose readings.

We all feel better here now, thank you, and your analogy of the gas tank makes sense. Thanks.

[eyelostit]

Hi Robert,
Glad you are feeling better than yesterday, it will take a little time for the BG to come down, and your understanding of diabetes you posted was right on target ! ;)

[robertpri]

Thanks, eyelostit,

readings after 11 hours

ketone--negative
glucose, just below the 1000 color--a bit lower

[BaileyBear]

That's wonderful, Robert - no ketones is a very good thing. :) The blood glucose regulation will come with time. You're doing great...especially with everything you have had thrown at you all at once! A few more days of the insulin in Nik's system and he will probably start feeling a lot better. After that, it's just a matter of patience and time to find the right dose and a routine that works for you and the pups.

Hoping you all get a decent night's sleep for a change. ;)

[robertpri]

Many thanks, BaileyBear,
This forum has been Mik's life-saver, and my sanity-saver.

[BaileyBear]

Many thanks, BaileyBear,
This forum has been Mik's life-saver, and my sanity-saver.

I know exactly how you feel. I think Bailey would still be sailing in the 500's and I'd be in a rubber room by now, if I hadn't found this board so early in the game. :rolleyes:

[robertpri]

My first injection coming soon this am, and unfortunately, a mandated long day at my p/t job.

Perhaps dumb question #1: if I cannot get Mik to eat anything [and historically, this could happen] what if I gave him a tablespoon or two of maple syrup? This has about 50g of sugar per tblsn.

My plan is a reduced insulin depending on what he eats, but if he eats nothing?

If the insulin "must" have glucose in the body to function, would this work?

Mik is unlikely to urinate this am--he never does, so dumb Q#2: how long after the injection is it "safe" to leave him, i.e., how long before any negative effects would happen--if they happen--after the injection?

[We Hope]

Robert,

First of all, if you can't get Mik to eat, you CAN give a reduced insulin dose. There is a bodily need for insulin called the "basal", or the insulin the body needs without taking food into consideration.

http://www.intervet.com.au/binaries/82_103335.pdf

This is from Intervet, Australia; Caninsulin and Vetsulin are the same product with different names. Most of the world knows it as Caninsulin, but it's Vetsulin in the US.

Page 15-

"If the diabetic patient is unable or unwilling to eat due to illness, administer a lower dose (approximately 30% of the normal dose) until appetite is restored."

Here you see them talk about the basal dose of insulin.

The problem with giving Mik sugar is that it's only a temporary fix. There are 2 types of carbohydrates: simple and complex. Sugar is one of the simple ones while things like bread, rice, pasta, potatoes and so on are the complex ones.

The simple ones are used very quickly by the body and also leave it quickly. The complex ones take longer to be digested, so they don't start producing glucose almost immediately, like the simple ones. The glucose that's produced by the complex ones also stays in the body a lot longer than what simple carbs produce.

What's told to people when they discover they're low is to first of all, take a source of sugar (simple carb that's fast to raise bg's). This gets their bg's up from a problem point quickly. But the sugar source works fast and leaves the system that way too, so we don't have anything to hold up the bg's and keep them higher, thus preventing another slide to low.

Not until we take some food with some complex carbs in it. People are told to have a sandwich (complex carbs in the bread of it) about a half hour after they take the sugar source.

So for Mik not eating and just getting the syrup, there would be no food "behind" that syrup to keep his bg's up and away from going too low.

Now on to the basal insulin question, which I'll post separately to keep this from running on and on like a freight train. :)

Kathy

[robertpri]

Many thanks, Kathy.

Looking at Mik right now, he is totally out--as he always is this time of day. I will wake him shortly and try for food, but wanted to first hear from the forum gurus.

Thanks for the quick reply, and I understand it.

So much for my maple syrup idea. I am trying to think of a complex carb that he might eat, and I'm already planning on 25% or about 1 unit.

Odd this timing worked out this way. My job normally requires me on site [40 miles away] by 7, or 8 at the latest. So, I will usually have to get this done by 6-ish.

Today, I'm working until 5 or so, and told them I will be in later this am.

[We Hope]

Now let's talk basal insulin. As you see above, it should be about 30% of the usual dose. If we take Mik's total dose of 5 units, that works out to 1.5 units BUT since this is all extremely new to you, I would go at it this way to make sure Mik doesn't have problems while you're at work.

We did these tables of insulin starting doses recently. They're based on starting insulin at 0.25 to 0.50 (1/4 to 1/2) unit of insulin per 2.2 pounds of body weight.

http://petdiabetes.wikia.com/wiki/Case_Talk:Niki

The closest weight to that of Mik is the 10 lb /4 kg one which says 1-2 IU. When I take 2 and multiply it by .30 (for the 30%), I get the result of 0.6, or 6/10 of a unit of insulin. I would round that down because it would be very hard to find a way to get .6 IU of insulin in the syringe and make it 0.5 IU, or one half unit of insulin.

Where you're most likely to have issues is when the insulin is "peaking" or when it's working hardest. For the intermediate-acting ones (Lente & NPH) this is around 4 to 8 hours. When we get to that point and there's more insulin than food, this is where a bad hypo can happen. As you saw in an earlier post, the 6-8 hour area is where Intervet suggests the larger meal be fed; this is to try to be sure there's enough food on the way to handle the one daily dose of insulin that's going to be "peaking", or working hardest.

Am going to suggest something because you are on the once a day plan-do you think it would be easier for you to try moving Mik's once daily to the afternoon or early evening when you're going to be at home?

Kathy

[robertpri]

"Am going to suggest something because you are on the once a day plan-do you think it would be easier for you to try moving Mik's once daily to the afternoon or early evening when you're going to be at home?"

Yes, that is my desire, but I fear leaving him for 6-7 hours with no insulin in his system. It would be FAR better for me to administer and monitor, but I'm afraid of leaving him without insulin.

Of course, being zonked out, I cannot see behavior or use a test strip.

As I noted, Karen had 13 years to train these guys that they don't eat until noon. I have never understood how she did this, but 33 years of 5 dogs was the same. They don't even get up until 11 or so.

[robertpri]

"We did these tables of insulin starting doses recently. They're based on starting insulin at 0.25 to 0.50 (1/4 to 1/2) unit of insulin per 2.2 pounds of body weight. "

This has been discussed here, and I'm kinda stuck. The Vetsulin site calculations is 1 unit per kilo or 5 units a day. I was going to give him 1 unit, if he eats.

[We Hope]

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

Vetsulin-Page 1

"The revised starting dose for dogs (0.5 IU insulin/kg body weight) is based on the average dose required to maintain adequate control in the original approval as well as in current recommendations in literature."

This Vetsulin dosing change was made last year--in early 2008.

http://www.intervet.com.au/binaries/82_103335.pdf

Intervet, Australia-Caninsulin Page 6

"The starting dose of insulin is 0.25-0.50 units per kilogram, twice daily-rounded down to the nearest whole unit."

http://www.anibrands.com/vitabone/ingredients.htm

Vitabone ingredients:

"Wheat Flour, Poultry Meal, Ground Wheat, Ground Corn, Corn Gluten Meal, Animal Fat (Preserved with BHA), Fish Meal, Brewers Dried Yeast with Molasses and Yeast Extract, Salt, Calcium Carbonate…"

Mik's Vitabones qualify as a complex carb; you can also find out how many carbs are in the baby food by reading the label. ;)

Kathy

[robertpri]

OMG! The paper that came with the vetsulin says 1 unit /kilo! That's double what this letter says!

Scheesh--thanks. You can be sure I will discuss with vet.

Good news on vitabones--!

baby food says

carb= 9g
fat = 1
sodium = 20
fiber = 2
sugars - 3
protein = 2
potassium = 200
calories = 70

this is per jar. Best I have ever done is about 1/2 jar, so half of those numbers.

[We Hope]

Robert,

When you read the "Dear Doctor" letter further, it will tell you that some packages were shipped with the old instructions in them and that they obviously will be available until those with the old ones are gone.

But they did instruct the vets to go with the 0.50 IU per kg despite what the package insert says.

Hope this helps!

Kathy

[robertpri]

It helps a great deal! thanks

I faxed that letter to vet, but he is difficult reach in the am. will call him later.

Meanwhile, plan B: if little or no meal, then it's .5 unit for this am.

[We Hope]

I agree with what you want to do if Mik doesn't eat or only picks, and that you and the vet need to talk about the letter and how those dosing changes can affect Mik's daily dose.

While we all want to see Mik's numbers come down and do that as fast as possible, we sure don't want it at the expense of a hypo.

Kathy

Adding here--when we looked into Caninsulin/Vetsulin for Lucky, part of what we looked at was their 1 IU per kg dosing scheme (had only that at the time). Had we gone with it, it would have worked out that we would have been starting him on more insulin than he wound up regulating very well on, which was just slightly less than 1 IU per kilo.

[robertpri]

How dramatic!

Old news to you guys, but this was my first shot.

Feels like a space launch!

Skinny and so little body fat, it was a challenge to pinch right, and a few false efforts, but finally got it.

Whew! Yes, I know it will become simple...thanks!

measuring .5 unit is tough--the syringe dividing lines are so close

add:

he did eat about 20 little pellet things that I had bought for a treat. would not touch anything else. Pellets are about 1/2 the size of a child's marble. I will go to that store tonight and see what's in them. The details were posted but I failed to write them down.

Mik went back to bed, as is normal.

Off to work--many thanks

[We Hope]

Robert,

If you think getting a half unit on a U 40 syringe is tough, it's even harder with the U 100 ones (for NPH and the like) if you're not using the 3/10 cc syringes with half unit markings.

At one time, I had to do both--was a lot more comfortable with doing it on the U 40 ones than the U 100's! ;)

Step by step, you'll both get there! :)

Kathy

[ladysmom06]

Hi Robert,

Nothing to add - just wanted to welcome you to the board and wish you luck with Mik.

Luv,
Lynne and Lady

[k9diabetes]

Have been trying to be a good patient and elevate my ankle so haven't been around much today. Glad to see you are getting lots of good input!

Natalie

[robertpri]

Wow--installed something and my post went away. Sorry if this doubled.

Came home and Mik seemed okay, not better, but OK.

He ate his dog food [surprise] and then I gave him the remainder of his daily dose or 2 units, making 2.5 for the day.

Later urine test shows

ketones = negative
glucose = around 250, but hard to say with those test colors so close. But it's WAY better than last night!

Talked to vet and knowing my horrible work schedule and Mik's non-existing morning appetite, suggests that I might try the once/day insulin regiment, but if not, then 25% in the am and the balance when I get home.

many thanks to ALL for the support and knowledge on this forum!

[peggy0]

wow Robert what a turn around :) That's great news!! Congratulations

[We Hope]

Robert,

You're fine--we got only the one post. :)

It sounds like Mik has had a LOT of improvement in the last day! With him now getting insulin regularly and no more ketones, he's feeling better.

When they're so high, most of them don't want to eat, which is really tough because without eating as you know, they can't get their full dose of insulin. Of course, leave it to mine to have been so high before pork insulin and to be so hungry, he could have eaten the furniture if it wasn't a LOT bigger than him! ;)

The insulin has done a tremendous job with bringing down those "red hot" results you were getting on the ketodiastix. With the results you had tonight, I'm so glad you had a word with the vet and Mik's daily dose has been cut--I would worry that a total of 5 units might mean he could have a hypo; he's come down so far and so fast.

If Mik wasn't feeling better, I don't think you would have had a "taker" for plain old dog food!

I think what your vet has said about the 25%/75% dosing depending on Mik's eating habits is a good one. It makes sure he gets enough insulin in the morning to take care of his body, but not too much so he goes hypo without having eaten enough food. It also has you at home when the larger dose is given, so you can keep an eye on him.

Maybe NASA ought to give you a job offer since it seems you have a real knack with "launches". :D

Kathy

[robertpri]

Thanks all!

I knew that I would be home late today [5 is late for me] but this job is not X-o'clock to Y-o'clock. I respond to the site situation, and impossible to predict. I could go in at 7am and be done by 10, or get stuck for 10 hours.

This was another reason I want to give Mik a small does in the am. I figure 25% [or 1/2 unit] is about as low or find as I can measure.

He is barking like crazy now, demanding something, which I never figure out. I have about five choices of food and he wants none of them right now.

Still, his barking is music to my ears...

[eyelostit]

Still, his barking is music to my ears...

And Mik ate !! :)

[robertpri]

worry here.

it's been three hours since the 2 units and mik is eating well, another 3/4 jar of baby food and kibble.

a minute ago, he began walking and stumbled, walked like drunk, his legs kind of collapsed once. he finally got going to the kitchen, he is eating agian

what are the signs of hypo?

is three hours beyond the worry time or..?

[We Hope]

Robert,

It sounds like he is too low to me. Give him some syrup about a teaspoon total--rub that on his gums and try getting some under his tounge. Be careful not to choke him with the syrup.

Let us know and then we'll talk about following it up with food in a bit, but please go with the karo now.

Kathy

[robertpri]

That was my plan but wanted to check first.

Gave him about 1/2 tspn of maple syrup, which i'm told is stronger [glucose] than karo.

more
should have noted that his craving for water is still high--not AS high as yesterday, but methinks above normal

more more

I have decided to not give him the 25% in the am, and should be home by noonish for his first meal + insulin

[We Hope]

The only time I had to use anything like this, I used pancake syrup. Lucky was at 35 and had no signs of being low. It was when we were initially regulating him.

http://www.bddiabetes.com/us/main.aspx?cat=1&id=399

SYMPTOMS OF MILD HYPOGLYCEMIA

Sudden ravenous hunger
Shivering
Weak, lethargic, unusually tired
MODERATE HYPOGLYCEMIA

Disorientation
Trouble with vision
Poor coordination, such as staggering or walking in circles. The dog may act 'drunk'.
Changes in head or neck movements
Restlessness
Urgent barking
SEVERE HYPOGLYCEMIA

Convulsions, seizures or 'fits'
Passing out

To jump-start a dog's blood glucose, give it light or dark corn syrup (such as Karo® brand) or maple syrup that can be absorbed quickly into its bloodstream. Give one teaspoon of syrup to a small dog, and one tablespoon of syrup to a large dog. The effect of syrup does not last long, but it works quickly to reverse a low blood sugar situation. Follow up the syrup treatment with a regular feeding to stabilize the dog's blood glucose. Sweet syrup can be applied to the animal's gums, inside of cheeks or inside of lips.

You should see Mik responding to the sugar pretty quickly. Then he's going to need to take more food--whatever he will happily eat--to make sure he doesn't have another problem.

I would work at feeding him as much as possible so that he doesn't have another problem when the insulin gets to working hardest and that would be roughly between 4-8 hours after the shot. The actual "peak" time will depend on how the individual dog uses insulin; right now we don't know this about Mik so we can't predict what his "peak" really is.

[We Hope]

With what happened, I think you're right to skip the morning insulin because you need to reach the vet to let him know that a total of 2.5 IU was too much for Mik today.

Now understand that because of the syrup and more food, Mik will be running high, but it's nothing that can't get straightened out. Whenever you think you're seeing a hypo, it's best to treat it and worry about straightening out the bg's later on because a hypo can kill. You have time to fix the higher than normal bg's, but even if you're wrong about thinking it's a hypo, better to be wrong and need to work on the bg's than to be sorry.

I think Mik's going to need to use less than a total of 2.5 IU, know that your vet needs to be advised of where 2.5 IU took him today and that he should be able to give you a dosage adjustment because of this. Mik may need only 2 IU or perhaps 1.5 IU total right now. I think you should have his input on a new dose for Mik.

How is Mik now?

[robertpri]

Excellent info, many thanks.

The problem is that Mik's displayed many of those symptoms for some time, and I think a lot of it results from his sudden blindness. He is confused, walking into things, and learning to find his way around.

One little trick he has. Mik knows precisely where I sit at my computer which is on a desk. He walks toward me until he literally runs into my leg, then turns left, hits the desk, and turns right to his little bed. It's odd, but he has it down pat.

I faxed the vet about Mik's status, and that I'm skipping the morning shot. I have decided to never leave him after a shot of any size. I gave him about 1/2 tspn of maple syrup, which he LOVED, and then put him down. After a while, he seemed to walk a lot better.

It's almost 10 pm here, past his normal bedtime so he went to his bed. He ate so much for dinner, that I don't have much hope of more, but we'll see.

[We Hope]

When you see something that looks like it may be a hypo or low and you give syrup then see improvement not long after that, then you know it was a low you were treating because giving a sugar source doesn't help anything else.

I'd keep a check on him tonight to make sure he's OK. While I think you're right if he ate well, it should take care of the peak of the insulin, but best to be sure. If you can get any more into him, I'd sure try.

We once had a situation on another board years ago where the dog had gotten his dinner and evening insulin and shortly thereafter threw up the dinner plus had a hypo. The evening insulin hadn't been in him long enough to cause it, so it had to stem from the earlier dose.

We kept him out of the ER by feeding him peanut butter and jelly sandwiches so he'd be high enough that when the evening insulin did peak, he sure wouldn't have another hypo!

I think what kept Mik on his feet yesterday after getting the 5 IU was the fact that his bg's were so high. Now that they've gotten down to more reasonable levels, he has less resistance to the insulin.

[robertpri]

We kept him out of the ER by feeding him peanut butter and jelly sandwiches [snip]
I think what kept Mik on his feet yesterday after getting the 5 IU was the fact that his bg's were so high. Now that they've gotten down to more reasonable levels, he has less resistance to the insulin.

PB & J! Great idea! Will keep it in mind. Yes, I agree on your yesterday comment. His readings were very high, and the 5 IU jolt brought him down to near normal, but that amount is WAY too high now.

I'm wondering about 2.5. Will discuss with vet tomorrow.

[We Hope]

My thought is that it needs to be less than 2.5 IU because that's the amount Mik had today and you needed to get the syrup. The very high bg levels are no longer there to create so much resistance. When you get rid of resistance, you need less insulin.

[robertpri]

The very high bg levels are no longer there to create so much resistance. When you get rid of resistance, you need less insulin.


Understood and agree. I'm going with about half or 1.50, and then test strips. I know ketones should be negative, but glucose around 200 or so? Less?

more
new strip

ketones = negative
glucose = I'm hard pressed to say 100 or 250. The color graduation is so slight, I could go either way. So, about 175-200?

[We Hope]

While your ideal is to get down to under 200 with the glucose, I wouldn't get upset about that right now. You can get there with careful tweaking once we can establish how much insulin Mik should be using now, in light of his going low tonight.

I would think about the under 200 after Mik gets onto a dose that keeps his bg's down and away from the horribly high ones he had which created the ketones and keeping the ketone check at negative.

The main thing now is to find a number of units for Mik which will do that--keeps them in check, keeps him eager to eat and he's stable on--meaning that his bg's are steady--no real highs or lows.

Once we can get there with Mik, you and your vet can adjust his dose a little where it might be needed to stay under 200.

Once Mik is at or under 180 (renal threshold), you won't be seeing any glucose results on the urine strips because the glucose won't spill over to his urine. This is where being able to test blood comes in handy because when we get a negative result on a urine glucose strip, all we know is that he's at or under 180--how much under only blood testing can tell us.

[robertpri]

Sounds good to me--thanks.

He did wake up and I managed to coax him to eat about 15 kibble nuggets. He went back to bed, and sleeping peacefully, gentle breathing, no abrupt movements.

[We Hope]

I'd keep an eye on him because it's been just about 6 hours since he had the shot--we are in the area of 6-8 hours where the insulin you gave him then will be working its hardest.

My thought is that when Mik was eating so well earlier, the food he was enjoying had yet to start digesting (turning into glucose), so that will be a help to fending off the peak.

Your getting him to take more kibble is more "insurance" against him having a problem.

But if you even think you see any hypo signs, don't hesitate to do what you did earlier.

[robertpri]

Yes, will do. I am accustomed to recognize his normal 'trouble-free' sleep.

[We Hope]

You've really had a crash course in this. Within a day or two you've been through bad highs and ketones and now dealing with a low!

[robertpri]

Heh, yeah.

He just got up for more water. Why is that? I thought high ketones hydrates. But those are negative now. He is still drinking a lot of water.

[We Hope]

High glucose without ketones can mean drinking a lot. My Lucky was living in the 500-600 and up range until pork insulin and had no ketones. He drank water and urinated like wild during that time.

The water helps to flush some of the glucose out of the system. Mik is going to be higher because of the syrup and extra food he had to take tonight when he went low.

One of the things that brings a dog or cat to the vet and the diagnosis is diabetes is because the person notices that the pet is drinking more and urinating more. It's a sign of diabetes that hasn't yet been controlled with or without ketones.

[robertpri]

Heh, I HAVE to find humor when ever I can. I mentioned how he finds his way to bed. I had moved to another chair, so he came at me, bumped into my leg, and then turned left, his normal path to bed.

But I was in a new place, so he turned left into the bedroom. I waited a bit, and he came out looking left and right trying to figure out what happened. It was a small bit of humor.

I put him back on course and he found his bed.

Mak went blind over three years and slowly learned his way around. He is amazing to watch. Hard to believe he's blind.

Mik is still struggling with it.

[We Hope]

When I was a kid, we had a dog who went deaf from an antibiotic shot. She was still quite young when this happened so she adjusted very well. I don't think she missed hearing.

At the time, there weren't any helps or guides to what to do about your non-hearing dog as there are now. You had to find out what worked for yourself. We were able to train her to respond to hand signals and if we needed to get her attention, stamping your foot on the floor soo she could feel the vibration would get her to turn and look at you. Then you could signal her with your hands.

[k9diabetes]

I'm so glad you have been here at the forum for support with the insulin decisions the past few days. I have been very worried about the amount of insulin they originally prescribed for Mik - felt sure that was going to be way too much once his very high blood sugar was reduced.

I totally agree that I'd like to see Mik on a small dose now and work up to the right one if more insulin is needed.

You have definitely had a trial by fire and you've done extremely well!

Natalie

[BaileyBear]

What a difference a day makes! I'm just amazed at what you and Mik have been through in such a short period of time. What a roller coaster ride! Some of us never see many of these events happen. Bailey's never had ketones, or a hypo, and he still has his vision. Congrats on handling everything so incredibly well. Robert...cool as a cucumber. :cool:

Once again, we see how resilient dogs can be. I always find the little stories about dogs adjusting to blindness (or in Kathy's dog's case, deafness) so interesting. It's neat how they all find they're own little tricks to get around and find there favorite spots and people. :)

[robertpri]

Thanks to this forum, I am not quite ready for the rubber room.

I gave nothing to Mik this am, and finally home deciding what to do.

We know 5 IU was a one-time thing never to be repeated.

I was going to cut in half, or 2.5, but worry that is too much.

Mik is semi-fine now, ate a good dinner, and time for shot.

I'm thinking 2 IU.....?????

I am really winging it here, and terrified of another incident like last night. I would rather sub-medicate that over-med. Right?

Meanwhile, to keep me from getting bored, Mak with the heart condition has decided to go on strike and eat nothing. Ergo, no pills, and he needs about 6.

Bought $50 worth of new assorted dogfood, wet and dry, and he ignores them.

Just another fun evening...

[We Hope]

Bob,

When in doubt, go with caution. You can always work later at correcting higher bg's, but you well know what it means to try bringing them up. Lows can harm or kill a lot faster than high bg's without bad ketones can.

I'm thinking more along the lines of 1 IU and see how that goes with you and Mik tonight, as that's half of last night's dose.

My suggestion for Mak would be that you try him with some baby food; we often suggest that for the diabetic dogs who don't want to eat. I'd try the trick of warming some in the microwave a little so the smell of the good food might be enticing, since they go by their noses.

Kathy

[robertpri]

I split the diff and went with 1.5.

The reason: his ketones are still negative, but gluose strip went really high, over a 1000.

[We Hope]

And with the strip results, I agree with you on that. :) He's had no insulin since last night, so I think everything should be fine. You say Mik ate well and that's one of the important things--that there's enough food in him for the amount of insulin he uses.

Did Mak settle for anything?

[robertpri]

Mik ate well, hi value kibble from the pet mart and baby food.

Mak---ah, I probably messed up.

It is essential that he gets heart/cough pills 4x/ day. He hates them and can detect them no matter how small I have pulverized them.

By last night, he would not eat anything with a pill in it. So, last desparate resort, I liguidfied one in a thick, plastic ML syring and put it in his mouth.

Well, you cannot imagine the drama! After spitting for five minutes, he ran into a corner for the remainder of the night. This am, for the first time in his life, he paid me no attention when I left.

Tonight, he just watches me like a traitor. I feel like hell.

[We Hope]

The only illness Lucky had after the diabetes diagnosis was a slight bout of colitis. Along with another med in pill form, he was to take X cc's of Pepto Bismol so many times a day. The pill was fine but not the Pepto Bismol in pill or liquid form.

I had to chase him all over the house to try to get those doses in; for the first and only time in his life, he bit me trying not to take the Pepto. About half of the total amount of the doses actually went in; the rest of it was on him and all over the house. We were calling him the Pink Panther. :D

Didn't like doing that any more than what you needed to do with Mak, but sometimes we have to do what we know is right and feel like hell a little bit.

Insulin's easy, compared to Pepto Bismol!

[robertpri]

4 hrs from 1.5 IU.

ketones - neg
glucose - still around 1000

but Mik looks good, sleeping peacefully, breathing well, no jerky movements

[eyelostit]

I think you're doing fine Robert, no ketones thats great, the 1000 with the urine is a past picture, if Mik can p again see what you get.

[robertpri]

Perhaps while I was at work, some Teamsters or UAW organizers dropped by and unionized my two pals.

Both appear to be on some kind of strike.

normal dog food--nothing
special dog food - nothing
kibble - nothing
baby food - nothing
favorite treat - nothing

Both looked at me in disgust and walked away.

Definitely organized.

[We Hope]

Bob,

Then it sounds like it's back to the half unit of insulin for Mik and back to the other kind of syringe for Mak. How did Mik do with his 1.5 units last night?

Kathy

[robertpri]

Bob,

Then it sounds like it's back to the half unit of insulin for Mik and back to the other kind of syringe for Mak. How did Mik do with his 1.5 units last night?

Kathy

Yep. He did fine, as far as I could tell. As usual, he was very lazy after the meal, and drifted off to his bed for most of the evening. But that is typical since Karen passed. Neither have the same spark since then, and it breaks my heart. I play with them as much as possible, but it's not the same.

Mak really bothers me. I used to say he would eat golf balls if they were in his bowl. It's been about 20 hours since he last ate, and that's two life times for him. Amazing.

[We Hope]

Neither of them are youngsters now either. Having had a Shih Tzu before Lucky, I can say that she was the most easily upset of all of our dogs. It didn't take much to get her nerves going, and when that happened, she'd be off on everything.

She liked to eat also but was fussy about what she was going to eat. Once a neighbor had a darn good loud fight; it was in their home, but loud enough to be heard outside of it. Even though the yelling wasn't in our house, it was enough to upset her tremendously.

[robertpri]

Yes, they are ultra sensitive, which is one reason Karen chose them after careful consideration and chats with many owners.

They could 'read' her gestures, and go lie down, come eat, or whatever she wanted just from a word or movement. They were fully tuned to her.

I have tried to coax Mik to eat 'something' for over three hours now. Nothing.

So, dumb question #375: do I still give him .5 IU on an empty stomach, and no real hope that he will eat? Or if his internals are off whack, could the .5 make him hungry?

I guess that's two questions

[We Hope]

Bob,

The half unit would be the basal, or body's needs without food. You'd given that to Mik the other day before going to work when he didn't eat in the morning. The problems came when he had the 2 IU later on, even though he'd eaten well.

Since he had the low incident and we only have the urine testing which says "negative", and that means somewhere below 180, the only safe option you had the morning after the problem was to omit all insulin until you got home and saw how he was going to eat.

Last night, you say he ate very well, and it wasn't until then that he got 1.5 IU from you. There were no problems last night.

He may decide to eat after getting the insulin; I knew someone on another board who actually did always need to give her dog the insulin first so she would eat. It's a risky move, because you're betting that he or she is going to eat. All I can say about this is that she had no problems but I wouldn't suggest anyone else trying it.

If Mik does eat after that, I would not do anything about a second "follow up" shot--you'll have to leave things as they are with him eating and only getting the half unit of insulin.

Kathy

[robertpri]

Thanks, I will go with .5

It is sooooooooooo bizarre! Both used to hang aound me in the kitchen while I did anything there. Even a fast trip for a coke and they were at my feet.

Now, neither one will even come to the kitchen.

bizarre

[robertpri]

If nothing else, I am getting good at it.

Mik did not even notice the shot.

wow--.5 is hard to read on that scale

[We Hope]

Could something have upset them both today while you were gone?

Caninsulin/Vetsulin has a magnifier you put over the barrel of the syringe. They include it in every box in the UK--not sure if they throw it in in Canada, but I've never heard that the US boxes of syringes get a magnifier put in them. Maybe we should ask our UK and CA friends who use Caninsulin about that.

The problem with buying the ones at the pharmacies and the various diabetes supply store online is that they are made to fit U 100 syringes; the barrels of U 100 syringes are thinner than those of the U 40 ones--they wouldn't fit.

[robertpri]

I can' say, but both have been upset-or odd--for a couple of days. Mak has not trusted me since I have to force the med down his throat. He's not big on forgiving. I think they both carry grudges.

Mik is frustrating because he goes to the kitchen and barks. I come to try food, all 7 or 8, one at a time, and he ignores them all.

Yes, I probably should not have given them so many choices, but at one time or another, they liked them all. Now, nothing.

[We Hope]

It's most upsetting for everyone when an animal has to eat because of meds and he/she won't.

It was rare for Lucky to refuse to eat; when we had that happen, I gave him his basal insulin dose based on the number of units of insulin he used. Never had to do it more than once in a day. If that happened in the morning, all would be well by evening and he'd be back to eating again.

But when it does happen, the person gets very nervous and worked up about it because he or she KNOWS the dog has to eat to get the meds. Both of your guys might be feeling a little of your frustration too. You get a little frantic and you start offering perhaps too many choices, as you said, where if the situation was that you didn't need them to eat for meds, you'd be a little more laid back about it and think they'll do it when they're hungry.

[robertpri]

Could be, but I'm not the emotional type, at least around them. Of course, after two hours of trying to get them eating, some stress "might" have snuck into my voice.

But Mik dabbled at some baby food, reluctantly, so that's it for tonight. They both crashed out.

[We Hope]

A lot of them can read us better than a book and can almost "smell" stress. ;)

[Margaret Boyle]

A lot of them can read us better than a book and can almost "smell" stress. ;)


Kathy, normally the boxes with the U40 syringes come with a magnifier I am not long on Caninsulin and I have only bought one box so far but if I get a spare I could post it out to Robert or if their are some other people who have maybe spares in their boxes I will be ordering more soon. I would imagine that
they would put the magnifier in every box US or UK or Canada but I am not sure.! :(

lol

[Fishslayer]

Hi Robert. Welcome to K9diabetes.

I'm terribly sorry for your loss of your wife. And now to have sick dogs heaped on top. I admire both your strength and your devotion to your furkids.

I'm a diabetes noob and the folks here and at the Cushings forum have literally been a lifesaver for Lucy. I count my blessings every time I read of dogs who won't eat, hold still, etc.

If nothing else, I am getting good at it.

Mik did not even notice the shot.

wow--.5 is hard to read on that scale

Kathy, normally the boxes with the U40 syringes come with a magnifier I am not long on Caninsulin and I have only bought one box so far but if I get a spare I could post it out to Robert or if their are some other people who have maybe spares in their boxes I will be ordering more soon. I would imagine that
they would put the magnifier in every box US or UK or Canada but I am not sure.! :(

lol

I use a pair of those magnifying reading glasses they sell in most any store. Makes loading the syringe WAY easier for this old fart.


Rick

[eyelostit]

I feel for you Robt. I lost my husband some time ago and had 3 dogs, they did not like the change, especially my lil one who was close to him, then we moved, oh my, they wanted to go home to other home, so did I, what a time in my life. Niki got diabetes a yr later :(

You really are handling the diabetes well, i think in time the doggies will come around.:)

[robertpri]

Thanks all, but I am not handling it well at all. Mik is actually showing small, small, small signs of improvement, but of course he is light years from the dog he was six months ago.

So many things have happened..

Mik ate some tonight, not nearly enough, but enough for another .5 basal shot. He reacted so horribly with 2 IU the other night on a relatively full stomach, that I am really hesitant about more than that.

Mak is my greatest fear at the minute. Not diabetes, but he MUST get his heart meds, and won't eat anything. Tonight, he consumed maybe a 1/2 cup of quality kibble.

I have a call into the vet right now.

And a BIG THANKS to all this wonderful support and information

[eyelostit]

Robt, did you ever try that cheese that comes out of a can, you push the nozzle sort of like you do with whipped cream, you could do a tablespoon or more of this, may be worth a try, Kraft makes it, should be by the crackers. Its easiest thing I know of, my vet would put this on the table for my dogs when she gave them their shots. Nice to hide pill in, are you allowed to crush these pills? Some you aren't supposed to.

[robertpri]

Have not tried it but will. The odd thing about Mak is that he "used" to try anything I put down. He may spit it out and not take more, but he would try.

Now, everything gets the 'sniff' test, and apparently he has some mysterious standards. Even his old best-of-all-time baby food fails his sniff test.

Just got off the phone with the vet and I described Mik's behavior and eating so far. He agrees to the .5 IU, and since Mik is surprisingly active right now, better than in days, he would like to try more food.

If I can get another 1/2 cup in him, then he wants 1 IU. Otherwise, .5

Mik does not seem to be as thirsty today. I measured his water bowl before leaving at 6 am. At 2 pm, there was no change in his bowl, and his urination appears to be less. [although he might be hiding it from me--has done that of late]

[We Hope]

Bob,

I agree with what your vet is saying about Mik's needing to eat a little more to get more insulin; we'd all like to see him eat more. ;)

We talked about the insulin depot earlier and it being a reason why you don't see instant improvement when you change the dose. I think since you've been able to get at least some insulin into Mik since he had the ketones, little by little, that depot has filled.

We want to put more into it, but that needs to wait until Mik decides to eat more. The amount of insulin he's getting with the half unit takes care of what his body needs and I think you're seeing the good results of that.

What the insulin is doing is letting Mik use the glucose for energy instead of using things like the body's fat for it. We're all set up to use glucose for energy--that's normal; diabetes alters that--insulin makes it work right once more.

Hope your vet was able to give you some suggestions about Mak. Anything I've had to deal with re: heart problems has been in people. Do know that if they're having problems on that score, they don't eat very well either--not until the problem is resolved.

Kathy

[robertpri]

Thanks Kathy.

I guess the moon was just right because they both blessed me with the consumption of about 1/2 jar each of baby food, and some good kibble.

I made a command decision and tried to split the dose to 3/4 IU.

At my age, I have uber-strong reading glasses, so seeing the lines is not so difficult as controlling the syringe plunger.

While Mak was eating the baby food, I pounded the meds down to sub-atomic levels, and then smuggled about three molecules into this food.

Never to be fooled, one sniff and Mak left the room.

[We Hope]

Bob,

As far as Mik goes, I don't think you're going to have any problems with the 3/4 unit. When he did very well the other day with his meal, you gave him 1.5 IU and you had no trouble then either; so much of this is based on the food intake.

Because we don't have Mik eating a set amount on a regular basis, we have to hold back somewhat on the amount of insulin he can get. I think if he had been eating more, thus being able to get more of a full insulin dose for him, you would have seen this improvement a little sooner.

The promising part is that the better he starts feeling, the more he'll be inclined to eat.

It's too bad we can't tell Mak what they used to tell some kids when they were supposed to eat stuff on their plates they didn't like-"hold your nose and hurry up and swallow it." ;)

Kathy

[robertpri]

Bob,

It's too bad we can't tell Mak what they used to tell some kids when they were supposed to eat stuff on their plates they didn't like-"hold your nose and hurry up and swallow it." ;)

Kathy

Agree to your first part--he actually seems a tiny bit better. Hope springs.

Sidebar on the second part: when wife was carrying second child, doc said, this is going to be a BIG boy! Do NOT let him fall in love with food, never call him a good boy for cleaning his plate, and never reward him with dessert because he ate well. Food is a fuel, and never let it become important to him. It worked--son is 6'2", 190, trim, and rarely finishes his plate, even in a resturant. He'll push it away when he's had enough. Interesting, eh?

[Fishslayer]

While Mak was eating the baby food, I pounded the meds down to sub-atomic levels, and then smuggled about three molecules into this food.

Never to be fooled, one sniff and Mak left the room.

Our departed mutt Shovelhead was that way.

He was on Rymadil the last few years of his life. We had to special order pills because he was the only dog on the planet that wouldn't touch the chewable tabs. There was even a warning to keep the bottle out of dogs' reach because they'd get at it & OD.

We tried hiding a tab in his bowl of kibble. When he was finished the bowl would be empty...except for the Rymadil tab...

We tried hiding the pill type in peanut butter, cheese, you name it. A few swishes in his mouth & PTOOOEY! He's spit out a clean pill.

Even putting the pill in the back of his throat you'd have to watch him. He was pretty good at working that pill back up & out.:mad:

Rick

[We Hope]

The people I know who are heavier than they should be all seem to have the same pattern of dealing with stress--they start eating in response to it and will eat anything when they're upset. The ones who are either the right weight or thinner seem to deal with it by not wanting to eat.

When he was taking heartworm meds, Lucky was taking one strength when he was heavier and another after he'd lost the extra weight. The brand was exactly the same--difference being the amount of the med in the tablets.

To try to help you identify the strength of the pills on sight, the pharma had color-coded them; they were all flavored to be chewable.

Lucky would take the green colored higher dose one and chew it without any "hiding" necessary. But the lower dose brown ones he wouldn't touch like that--you had to put them in something to get them down him. :confused:

[robertpri]

Shovelhead We tried hiding the pill type in peanut butter, cheese, you name it. A few swishes in his mouth & PTOOOEY! He's spit out a clean pill.

Rick

It never ceases to amaze me how a dog [or cat] can somehow detect even trace elements in food. Once Mak notices even the scent of a med, game over, good-bye, you cannot fool me!

Shovelhead? What a great name!

[robertpri]

Finally a sample

ketones = neg

glucose, high, perhaps over 1000.

But this is not taken from a "clean puddle". Mik is well trained, but since this diabetes thing, he cannot quite make it to his place. So, he goes on the throw rug just short of his place.

Could I be getting something off the rug that pushes the glucose? Considering this rug has been 'hit before, could I be getting residue from earlier puddle?

[We Hope]

Bob,

It's entirely possible that you might be picking up something from the rug. Any urine that may still be in the rug gets "wet" again when Mik uses it. We know there's glucose in the previous urine.

http://www.peteducation.com/article.cfm?c=2+2103&aid=257

"Glucose will appear in the urine of dogs if the blood glucose level exceeds 180-220 mm/dL. A determination of blood glucose tells us what the blood glucose level is at that particular time. A urine glucose test does not tell us what is going on at the time the urine sample was obtained; it is an average of the glucose level in the urine which was formed since the dog last urinated - that could be 8 or more hours ago. Insulin dosages should NOT be changed based solely on urine glucose levels."

http://www.bddiabetes.com/us/main.aspx?cat=1&id=400

"If you plan to reuse the collection device, you will need to clean it well each time or the next test result may not be accurate." ;)

Kathy

[robertpri]

I suspect I'm picking up previous ones. I use test strips.

I'll wash the rug or replace it.

On another note, I have tried about 15 times to upload Mik's picture. Every time it says, "upload failed'

It's less than 100 x100 and only 10kb, and I've uploaded to other sites.

Must be doing something wrong.

[We Hope]

Bob,

I AM seeing Mik's picture on your member page. Let me see if I can take that photo and make it into your avitar too.

There you go! ;)

[robertpri]

Ah, thanks.

Poor little guy looks so sad...so do I

[We Hope]

Bob,

On your member page, you're able to start a photo album. If you have some other pictures of Mik and also some of Mak, you can upload them into one. Maybe we can find a happier picture for both your member page and your avitar.

[BaileyBear]

He is such a cutie! :D

I'm sorry you're having such a tough time with them lately. One dog giving you problems is hard enough - 2 is rubber room time.

I know you've been trying just about everything to get them to eat well. Just another suggestion - have you tired parmesan cheese sprinkled in it? When Bailey's numbers were really high and he lost all interest in food, parmesan really helped. You just have to be careful to mix it in well or they may just lick it off the top.

I wish I had some trick for getting a pill in a dog. Bailey would eat a rock if I handed it to him...especially covered in cheese. He takes Thyroxine twice a day and loves getting his pill. If I say the word "pill" he runs to the kitchen. It's bizarre. I know he's excited about the cheese, but he just swallows it anyway, so I'm not sure why it's so exciting for him, lol.

Do you know if the heart medication is manufactured by more than one company? Maybe the version you have has a smell he finds particularly offensive and a different version would be easier to give him. I noticed that years ago with predisone. I have a really strong sense of smell and a refill I picked up was not the usual brand I had received in the past. It smelled so bad to me that I kept gagging when I tried to swallow it. Thankfully, they were able to switch me back to the brand they'd been giving me for years.

I hope the little guys are doing better this weekend. We're all rooting for you and the boys, Robert. Hang in there. :)

[robertpri]

Thanks, BaileyBear,
We used to joke that Mak would eat golf balls. No longer.

Oddly enough, neither had problems with steroids or lasix, or a dozen other pills. But this one must reek of odor.

I am fighting a bit of conflict, that I must decide, and that's not easy. As noted, Mak has lost all faith in me, and I think that's extension of losing his primary owner, my wife.

He was never the same after she passed, and it took months for me to instill some confidence in him. Mik was the same to a lessor degree.

Mak is ultra-sensitive. He would come to the kitchen and eat and then more or less disappear. Weeks/months of close contact and love had brought him to me, and he would actually repeat what he did for my wife, follow me into rooms and look for attention, wagging tail, begging for my petting hand.

It was wonderful.

But I had to force those meds down his throat, and I can actually witness his shock and surprise, like I turned on him.

Only dog lovers like people on this forum would understand.

He did not eat for three days, just hid behind chairs and watched the traitor.

Tonight, he ate about 1/2 of normal, which is a start. Vet said he was more worried on the short term for the lack of nutrition.

Tomorrow's another day.


many thanks to all

[k9diabetes]

I apologize as I haven't had a chance to do more than skim your thread...

What med is he getting and how big is the pill?

What's working for my cat, who cannot be pilled, is salmon flavored cream cheese wrapped completely around the pill and then I drop that very lightly onto a shallow dish so it's not "stuck" to the dish at all and hold the dish up so he has to kind of pick up the ball of cream cheese in a wad. It's all stuck togther. Once in a while he manages to pick the pill out after he takes it up but usually he just swallows it.

Chris' pills were bigger and I used to push them down inside a cube of cheese.

There are also Pill Pocket treats... not sure if you have ever tried those.

They worked well for Chris, who was not a picky eater, like most dogs. But didn't work for the cat, Gus. I was about frantic until I came on the cream cheese.

Just a couple more ideas.

This was putting the pills in whole, not crushing them.

Natalie

[robertpri]

I will try the cream chz. Bought $8 worth of pill pockets and neither dog will touch them. Failed the sniff test. I have got to find something that meets their mysterious, undefined sniffing criteria.

[peggy0]

Hebrew National low fat hot dogs :) they have no sugar. I stuff any pill for forbin in it.

[robertpri]

I will try anything. Mik ate one little ball of crm chz, then no more. Mak has eaten maybe 1 cup of food in 4 days. I have 9 different foods and treats--wont touch any of them.

Mak, this am, ate maybe 1 tblsn of baby food and left.
Mik at a little more, maybe a 1/2 cup total of wet, dry, crm chz.

Very frustrating

[peggy0]

Maybe try a scrambled egg?

[robertpri]

No change, no appetite on either dog. I thought the crm chz was a winner--Mik ate a couple of rolled balls, then lost interest.

Time for his shot, and same dilemma. I guess I'll stick with .75 IU.

No puddles that I can find to sample. Either holding it or hiding it.

[We Hope]

Bob,

I'd go to 0.50 IU--last night when you gave Mik 0.75IU, you had some eating going on. He'd eaten some, but not enough to "qualify" for the vet's thought of getting 1 IU.

If Mik's feeling better, he's probably not drinking and urinating so much.

I would stay with 0.50 IU when the eating's not good or if there isn't any. In that way, Mik gets some insulin for his body, but not enough to send him into a hypo because there isn't enough food to go with it.

Kathy

[robertpri]

Good idea. What little he did eat was hours ago. .5 it is.

[We Hope]

Bob,

Make a note somewhere that 0.50 IU is the dose Mik gets when he eats little to nothing. Agree with you that it's too risky to give more based on what he ate some time ago.

Kathy

[robertpri]

Bob,

Make a note somewhere that 0.50 IU is the dose Mik gets when he eats little to nothing. Agree with you that it's too risky to give more based on what he ate some time ago.

Kathy

Heh, as wife used to say, I am anal obsessive fanatic about keeping records.

[We Hope]

Just don't be like my mother, who was well-known for putting things away so well, she couldn't find them easily. My father used to say that if he wanted her to find something she'd put away, he'd need to ask a month before he needed it to get it. :D

[robertpri]

Heh, I might make great lists, but my kitchen looks like the food prep area for a dog kennel. The counter is covered with, count them, 13 different boxes/cans.

BTW: I have purposely avoided this final desperation, but just out of curiously, I had to see if their refusal to eat is set in stone.

I rarely give them Cheerios because of the .5g of sugar per cup But I gave each about 1/4 cup and they gulped them down before I closed the box.

There are some things that even they cannot refuse.

Now, Mik is in the kitchen barking like crazy. Gee, I wonder what he wants.

[We Hope]

Bob,

If that's what works, then you have to go for whatever does. When you can't get them to eat and you obviously need to, you go for the option that gets them to do that--even if it's not what you'd really like to see them eating. ;)

Kathy

[peggy0]

funny. they know what they want don't they? they will have great cholestoral.

[We Hope]

Bob,

I'm gonna make a suggestion here to try to get more insulin into Mik.

My suggestion would be that Mik receives a basal dose of 0.50 IU in the morning whether he eats or not. Then, 12 hours later, when it is time for dinner, that he receive another dose based on what he was willing to eat.

If he's eating little to nothing, then the second dose would be the 0.50 IU. If he's done fairly well with the food, then it would be the 0.75 IU you gave him the other night when he had eaten some, but not enough to "qualify" for getting a whole unit.

If he eats all of his dinner, then a whole unit for the evening dose.

What I'd hope to see happen here is that it would give Mik more "opportunities" for him to get the insulin for his body he needs, but by basing it on what he's willing to eat in the evening, the second shot would vary according to that so there would be no more hypos.

Thoughts, please. :)

Kathy

[k9diabetes]

LOL... Cheerios! Ugh, I don't even like the smell of Cheerios! Well, it's good to know that they aren't uninterested in food as a whole!!

We have been working with Jack and his terrier issue but I don't think Cheerios would do it!

Natalie

[robertpri]

Kathy,
I had considered that am shot, but I leave around 6 am. Getting him awake is a challenge, must less eat anything. [although he would probably not resist cheerios]

I will discuss with vet on monday.

Natalie,
I love cereal, and years ago dropped some cheerios on the floor. They grabbed them up like diamonds. Since then, it's only been a tiny treat once in a great while, like a tablespoon or so.

I guess they remember.

[We Hope]

Bob,

He wouldn't need to eat in the morning at all to get the 0.50 IU. It would be enough for his body's needs without food and without there being too much insulin to cause a hypo.

If you can get him to eat Cheerios regularly in the morning, then you could think about going at it a bit differently, but giving him his morning basal without food shouldn't mean he would be in trouble while home without you.

Kathy

[robertpri]

I just discussed this with Natalie [thank you, thank you] because Mik ate the best meal he's had in days. So did Mak!

each
1/2 jar baby food
1/2 cup good kibble
1/4 cup cheerios
and 1/2 kosher sugar free wieners [really love those1]

My concern was that Mik is walking odd, tripping, almost drunk-like, similar to when he was hypo, but that is not possible. Last insulin was .5 yesterday.

Unfortunately, his walking behavior is hard to read because he went blind so fast that he's always a bit confused and not sure-footed. He will stagger a bit, scares me, then suddenly move across the room just fine. Hard to read.

I gave him 1 IU and watching closely.

[We Hope]

Bob,

Whatever these two term haute cuisine, if they'll eat it, that's the important thing! :)

[robertpri]

Bob,

Whatever these two term haute cuisine, if they'll eat it, that's the important thing! :)

What is really odd is how they will not touch the vet dog food they ate since birth. Sniff and walk.

Nothing really appeals to them until I get their taste buds going and juices flowing with a small portion of baby food.

That worked today. After that, they ate the kibble that they refused 15 minutes earlier.

Again, those Hebrew Nation sugar free wieners were a HUGE success!

[peggy0]

Those dogs have good taste :) glad they worked

[robertpri]

Those dogs have good taste :) glad they worked


Yes, many thanks!

I see in your sig that you use Blue Buffalo. That is the 'senior' kibble I am serving to my very discriminating and particular clientèle.

[peggy0]

Yes my dogs love it. I feed them the weight control version :)

[robertpri]

Thanks to this site, I am soooooooooo thrilled!

Cut the sugar free wieners into marble sized chunks. Fed four to Mak, then slipped him two with meds!

Better than pill pockets...

[peggy0]

Works like a charm :) The weenie smell outdoes the med smell everytime. Glad it worked for you

[robertpri]

Works like a charm :) The weenie smell outdoes the med smell everytime. Glad it worked for you

It was a fabulous tip! I can't believe how he just gobbled it down. Not even a dirty look. I was truly worried because he needs 6 pills a day. I force down just one, and he's GONE for the day! Hides from me.

Now, I have a method that works.

Unending thanks!

[peggy0]

One of those hot dogs has 50 calories, no sugar, 1 gram of fat and 2 carbs. They are all beef. You'll have to see if they raise his BG. Boiled chicken raises my dogs, but if they get the pills into him, so be it.

[BaileyBear]

Fantastic! Glad the hot dogs are working so well. Hebrew National are my favorite hot dogs...Mik & Mak have excellent taste. :D

My parents had a Shih-Tzu who was bonkers for Cheerios too - her absolute favorite treat and the one thing she wold eat when wasn't feeling well. Maybe it's a breed quirk, lol.

[eyelostit]

Glad the Hebrew hot dogs are working, now I need to buy some of those hot dogs, I've never tasted them ! ;)

[peggy0]

YUM!! they are delicious!!!

[Cara's Mom]

Hi Robert, Mik and Mak!!(I love those names!!)
Have nothing to add, just wanted to say: "Welcome"! I see you have had some very good advice and you are doing an excellent job! Keep up to good work:)

[robertpri]

Thanks all.

Of course, Mik & Mak have mysteriously come to believe they are in charge. No idea where that came from.

So, now they wait for the wieners. Patiently.

Gave 1.5 IU to Mik and watching closely. He ate well, ketone's are neg, but glucose still high. Hard to read those color references, but methinks over 1000, perhaps 1500. Got to get them down.

In my eternal quest to find something they like, I found "natural foods, entrée for dogs, loaded with chicken, rice, vitamins from a healthy dog store.

Not cheap, but they love it.

Between the wieners and this stuff, have to visit Costco to see if they have any of this stuff cheaper.

[robertpri]

Hi Robert, Mik and Mak!!(I love those names!!)


Heh, since they did everything together, rarely separated, wife would just call them together, "MIKMAK!"

They leaped together.

[We Hope]

Bob,

What was the outcome of asking your vet about Mik's having a basal morning insulin dose even if he eats zero, and then his evening one to be based on how well he does eat?

We know we need to get more insulin into him, but that's determined on the way he's eating.

Kathy

[robertpri]

Bob,

What was the outcome of asking your vet about Mik's having a basal morning insulin dose even if he eats zero, and then his evening one to be based on how well he does eat?

We know we need to get more insulin into him, but that's determined on the way he's eating.

Kathy


He agreed, but I often get the impression that he is learning along with me, thanks to this forum. He is very good vet, but not highly experienced with pet diabetes. I told hiim Mik's insulin would go up in gradual steps.

Tonight, he ate very well, so gave him just over 1 IU. This am, .5 with some minor food.

[We Hope]

Bob,

Sounds good to me! Being consistent with the insulin is what gets the bg's down. What I mean when I say that is now that Mik is giving us more "opportunities" to give him more insulin, it's this consistency--basal only in AM if no breakfast and second insulin dose based on Mik's meal--that should start helping to get rid of those high urine results.

What they used to do to try to keep diabetics going in the years before insulin was isolated and available for use was to feed diabetes patients extremely little. They knew that the food they ate made their blood glucose rise but they had nothing to lower them with. So they were able to eat only enough to keep their bodies alive--a "starvation diet", if you will.

I think once you get into the habit of that morning dose and the evening dose based on what Mik eats, you will see him improve even more. ;)

Kathy

[robertpri]

Thanks,, Kathy, that is my goal. I was lucky at 5 am because Mak got up, and that triggered Mik. Once in the kitchen they ate a tiny bit.

What worries me is when they are fully asleep. My plan is to carry Mik to the kitchen and get him going with wiener bits. [he won't wake or come when sleeping--he zonks out] Then a small dose.

[We Hope]

Bob,

The 0.50 IU is fine even if Mik won't eat, but so much the better if he might start eating in the morning, because it might open the door to him being able to have more than that if he starts eating something in the morning.

I agree with you about not giving him the shot while he's asleep because it could be a frightening thing for him.

[robertpri]

Not doing well today. I tried to rouse him at 5 am, no luck. I could not give him even a small shot and then be gone for hours.

At 2 p, he would not eat anything except, you guessed it, wieners.

So, I gave him about one to get something in his tummy, then 1.5 IU.

He needs the insulin, but I've got to get food into him.

Scheesh---

It's a catch-22: he needs food for the insulin, but has no appetite until he gets the insulin, which he needs, etc

[peggy0]

Robert

If you boil the hot dogs, or even microwave them in some water, you can pour some of the broth over his kibble. It will taste like the weenies but get some kibble in him. May be worth a try

[We Hope]

Bob,

Couple what Peggy said with the marvelous smell of the hot dogs when they boil. ;)

[peggy0]

It would sure wake me up :)

[robertpri]

Robert

If you boil the hot dogs, or even microwave them in some water, you can pour some of the broth over his kibble.

Timing is everthing, eh? I just finished rinsing out the boiled water.
Oh well, next time

[robertpri]

Not doing well.
Ketones began showing trace last night and this am, and glucose still high

Got up at 5 am, and roused Mik enough to eat a bit, about 1 wiener, which is all he wanted. Gave him 1 IU insulin and will check urine when I get home around noon.

He is drinking a lot of water again--need to get more foor and insulin in hm

[peggy0]

Did you try putting broth on his kibble?

[robertpri]

Yep, but sniff and walk.

It seems that what they like one day is repulsive the next.

Rather like my kids when they were young...

Mak loved the wieners, but now doesn't.
Mike still likes them

[peggy0]

I know you've tried many things. When my older dog wouldn't eat, I would do boiled chicken, hamburger with rice or cottage cheese. As you know the hot dogs work as well. I'm so sorry we can't find something to help you :( I know how frustrating it is.

[Margaret Boyle]

Yep, but sniff and walk.

It seems that what they like one day is repulsive the next.

Rather like my kids when they were young...

Mak loved the wieners, but now doesn't.
Mike still likes them


Robert,
My heart goes out to you coping with two dogs who are picky eaters and trying to work it must be a nightmare for you but you are putting a lot of effort into it Robert well done :D:D


LOL

[robertpri]

Have been trying to get Mik to eat something for two hours--nothing but two wieners. I must begin the insulin, so with the 1 IU this am, I am plannning on 1.5. He's showing trace ketones so I want him to have 2.5 today

[We Hope]

Bob,

I believe you'll need to try going with that and keeping an eye on him for a low. If you notice that the ketones go further than this, you'll need to let your vet know or take him to an ER.

Really hoping all goes well because the 2.5 IU is what should be a starting dose for Mik based on his weight.

Kathy

The other option I can think of would be to have Mik hospitalized and get him regulated there where they can see that he eats and gets enough insulin. Most of us don't need to do it like this, but since Mik's appetite depends on getting insulin and you can't push the issue too far at home without the fear of a low/hypo, it might be something to consider to get him on the right track.

[robertpri]

"...2.5 IU is what should be a starting dose for Mik based on his weight.

Please define "starting"...?

you mean the max because that was my calc based on .5 IU/kg wt.

about 10 pounds

more

his ketones show neg now, about 3 hours after the 1.5 iu, but glucose still high, 1000 or so--hard to read.

He ate and zonked out, so will not surface to uninate for a while.

[We Hope]

Bob,

When there's talk of "starting doses" this is based on weight per kilo and it implies that the dog will be eating well enough to be able to have the full dose or doses of the insulin.

Since it's rare that where you start with is where you end up when the dog is regulated, you would then go up or down for the next step--increase or decrease--based on where you began; most are insulin increases from the starting dose point.

If Mik handles the total 2.5 IU well, this will be a victory, because I can't recall your getting this much insulin into him total in a day.

Kathy

Not counting the 5 IU he began with; if he didn't have very high bg's and a lot of insulin resistance at the time, I believe he would have had problems continuing on that dose.

[robertpri]

Understood, thanks.

I felt the 2.5 today was okay because of 1 in the am after eating, and 1.5 in the Pm, although I admit to taking the easy way out.

I 'served' small portions of all the various things he has liked in the past, for about two minutes. No-go, so I picked it up and waited.

10-15 minutes and then another "selection"

After a couple of very frustrating hours, I caved and gave him nathan's weiners. Not even a contest...

Best I could do, but I wanted that insulin to bring the numbers down.

[We Hope]

You have to go with what Mik is willing to eat and the times he's willing to do that, because that's the only way to get more insulin into him.

[robertpri]

You have to go with what Mik is willing to eat and the times he's willing to do that, because that's the only way to get more insulin into him.


Yep...that is my fall back position, but keep trying [hoping] for real food.

[k9diabetes]

Hi Robert,

I still think you may wind up having to go with feeding them one meal in the evening and giving just a small amount of insulin without food in the morning. Seems like they're much likelier to be hungry on one meal a day and you wouldn't have this constant battle to get them to eat earlier. Certainly would be worth trying.

There's really no reason it can't be done this way forever.

Probably very very rare for a vet to have seen this done but I've seen a couple of dogs over the years who just would not eat early in the day and this system worked really really well for them.

When Chris was sick his last six months or so, he often refused to eat so we would do the basal insulin dose and skip his meal. It was a lifesaver for us during his last year as he went through some long periods where he did what Mik and Mak are doing - eat something fine for a day or two and then refuse it. Even things like hamburger, which he loved.

I know you'll find a system that works for you guys. Just don't feel like you have to stick to the two meals a day.

Natalie

[robertpri]

Thanks, Natalie, but to be honest, it's not two meals a day. More like 15, but they only consume a few bites of one. Or two. But Mik still likes the Nathan's so I can get something into him

I have NO idea how much of anything a dog should eat. Karen always managed this, and it was 1 3/4 can's of vet canned dog food, half in the am, half in the pm.

I cannot estimate how many wieners or cheerios, or kibble. So, I know that composition means everything, but i kind of guess by "size", ie, roughly the same volume as 3/4 can of dog food.

So, when they do not eat the equivalent volume of 3/4 can, I figure that's low. ????

Any way to do this better?

[peggy0]

if the hot dogs are hebrew national low fat, each hot dog is 50 calories. A can of perscription dog food is about 350 calories. There isn't much carbohydrate in hot dogs, its mostly protein. The carbohydrates in cheerios, kibble and canned dog food give them a fuller feeling so you don't have to feed them as many meals as they digest slower than protein. While hot dogs have 2% carbs, dog food typically has 45% carbs, so you can see the difference. i know you have experimented with lots of food but I'd really try to find a canned dog food they will eat as its more balanced, or try adding rice or whole wheat pasta to their hot dogs ro provide the carbs. I've read that older dogs who don't want to eat also enjoy pumpkin. I haven't used it but several folks here add it to their dogs diet. I don't believe its pie filling; but puree'd pumpkin.

I have a little shitzu/dachsund mix who loves to turn his nose up in the am, as he knows the treats come out when Forbin gets his shot. Smart little devil. He's learned he does'nt get one until he eats. I know you feed Buff. blue kibble. Have you tried their canned? I mix kibble and canned together and pour a little bit of broth i make with hot water and a spoonful of the canned and the little brat eats it. If the canned food is cold he walks away. :) They all get one over on us don't they

[robertpri]

I have long concluded what wife told me for years: both dogs are smarter than me, so don't even try.

I have tried about 6 diff cans, sniff and walk away. I can have success with one, and the next day it's radioactive.

Oddly enough Mak LOVED the wieners for two days--it was great for sneaking in his heart and lung pills.

But he got wise, and won't touch them now.

I'll go for another few cans of "something" later today.

[peggy0]

Ah They just know how big your heart is and you'll keep giving them the good stuff :)

[robertpri]

Sorry to be the whiner, here, but lordy, it's sooooo frustrating.

Neither will eat today--Mik managed about 1/2 wiener, and Mak sampled some new Purina food. I thought we had a winner, but he had a few bites and walked.

Nothing else works today....

Mik's ketones are neg, but glucose higher, maybe 1500 or more. It's hard for me to read those colors.

Time for a shot, but debating on what to give.

this would normally be time for 1.5 but hesitant


more

Darn! as I walked away I spoted a puddle and tested it--ketones way up--but i don't know how old the puddle is

[We Hope]

Bob,

How much insulin before now? Has Mik ever eaten the amount he has tonight, gotten 1.5 IU and not had a low episode?

Kathy

[We Hope]

Bob,

Then you need to call your vet or get Mik to ER. They were there at one point and it's time to get him into somewhere to get treated.

Kathy

[robertpri]

fresh puddle--ketones between trace and low

glucose high, but it's been the same high for some time

he ate another full wiener, so 1.5 s/b okay

[We Hope]

As long as you've learned that the ketones aren't what you thought they were. Then yes, I would try going ahead with the 1.5 IU. Did Mik have any insulin this morning, even though he probably didn't eat, and if so, how much?

Kathy

[robertpri]

He ate another wiener and some cheerios. Gave him 1 IU since he ate more than the basal level of no food and .5

[We Hope]

Do I understand that Mik got 1 IU this morning or is this what you just gave him?

[robertpri]

1 IU around 12 hrs ago, and 1.5 now.

He's had 2.5 [total=one day] before with about this small amount of food. If less food, I lower it to .5 and 1 or 1.5 for the day.

more--

Mik's blindness is about total now. Mak learned his world over time, and I can tell that he senses movement and shadows. I can approach him and he kind of knows. He sees blurry visions

Mik seems to have lost it completely, as the vet said he would.

A week ago, mik could sense light and he would follow it into another room when the light was turned on. Now, he does not seem to know.

Odd, he can "see" or "smell" a pill 10 feet away, but not his food. If it's 2 inches away, he can't find it. I keep moving the food to him.

BTW: he just had a surge in hunger and ate another full wiener--not the best food, but I'll take it

[We Hope]

Glad to hear that Mik was eating something in the morning so he could do better than the 0.50 IU basal!

I know he really needs more than he gets, but we need to get him eating well enough to think about going up with it. When are you scheduled for a vet follow-up with him?

Kathy

[robertpri]

snip When are you scheduled for a vet follow-up with him?

Kathy

Monday or so. The insulin might have given him a boost? He just gobbled down a 1/2 bowl of cheerios.

Now, maybe some real food, but little interest so far

[We Hope]

Bob,

When you can get and keep Mik eating, the insulin can be adjusted for the things he's willing to eat.

I think Mik feels better after the insulin because it's dealing with the excess glucose. He feels better and more like eating. ;)

Kathy

[robertpri]

Bob,

When you can get and keep Mik eating, the insulin can be adjusted for the things he's willing to eat.

I think Mik feels better after the insulin because it's dealing with the excess glucose. He feels better and more like eating. ;)

Kathy

Ketones went to negative 2 hours after the insulin, and glucose dropped a bit. Tried to the next two hour to see what my little connoisseur would eat.

Apparently, my menu was beneath his standards. Sniff and walk.

[robertpri]

How many times does one use the same syringe? Right now, it's only one time for me, as I saw the link showing how needles wear out so fast. So, I have a small box of single uses, and I suspect I will just go buy more.

But wanted an opinion...

[peggy0]

Hi Robert, I only use my once, but I know folks that use them twice. I'll see if I can find the picture that shows a needle after one injection

From the products web site:

Can the syringes be reused?
A: Insulin Syringes are designed for single use only, and are clearly labeled as such. Today's insulin needle is thinner and more delicate for greater comfort, so needle reuse can damage the tip and cause injury. Use only once.

[We Hope]

Bob,

First of all, a caution. Vetsulin syringes are U 40 syringes; what you get in the pharmacy are U 100 syringes. The U 40's have a red cap, and the U 100's have an orange one. Your vet has the U 40's.

http://images2.wikia.nocookie.net/petdiabetes/images/6/69/Disposable_Insulin_Syringe.jpg

This is a U 100 syringe made for U 100 strength insulin; top syringe is a 1/2 cc syringe while the bottom one is a 3/10 syringe.

http://images1.wikia.nocookie.net/petdiabetes/images/9/9d/40iusyringe.jpg

This is a U 40 syringe made for U 40 strength insulin; this is a 1 cc syringe.

If you put them side by side, you would see that the barrel of the U 100 syringe is thinner and that the markings on that syringe is much closer together than those on the U 40 one. This is because of the difference in strength of the insulins; if you were to take a 1 cc U 40 and a 1 cc U 100 syringe, fill them with water and measure the contents, they would both hold 1 cc of liquid. Same is true for the 1/2 cc and 3/10 cc syringes--the amount of liquid they hold would be the same.

While it is possible to convert the dose to using U 100 syringes, I would say to stay with the U 40 syringes now because I think it might become confusing with Mik's doses changing so much.

What used needles look like close up:

http://images2.wikia.nocookie.net/petdiabetes/images/4/49/Newneedle.JPG

The syringe needles all have a silicon coating on them. Re-use of needles can mean this coating begins to flake off. It can get into the insulin vial and possibly interfere with its activity.

http://web.archive.org/web/20071021211550/http://www.vetsulin.com/PDF/20909TechBull.pdf

Page 3

"In addition, clients should be advised not to reuse insulin syringes. The silicon coating inside the syringe can contaminate the insulin vial with silicon. A white precipitate will form in the vial which may interfere with the biological activity of the insulin."

If you're not going to make it with the syringes until Monday, then you'll have to do a little reusing.

Kathy

[robertpri]

Yes, I saw those pics, but was unaware that the 40's are only sold at vets.

[We Hope]

Bob, I can give you a place to order U 40's if you like, but you'll need to get some from your vet to get by with until they come.

http://www.vetrxsupply.com/itemdesc.asp?item=09260&ref=srh&srcfield=itmdesc&SearchFor=U-40&itemsPerPage=10&recstart=0

I always bought from this company. The link shows U 40 1/2 cc syringes. While you can get a 3/10 cc syringe from them for U 40 insulin, it comes with a syringe disposal box and there's a $5 difference in price for the disposal.

The ones shown at the link come in a cardboard box--$17.99 plus shipping for 100 syringes.

When we started with Caninsulin/Vetsulin, the insulin wasn't yet approved, so there weren't any Vetsulin syringes here either. This is when I started ordering from this company and continued. I never had a faulty syringe from them and all of the syringes are made in the US.

Since this company now also sells U 100 strength syringes for pets, if you order from them, be sure to make sure you are ordering the U 40 syringes.

Kathy

[robertpri]

Excellent-thanks.
I have a call into the vet to see what he has on hand.

[We Hope]

Back not so long ago, U 40 insulin was sold in the US for people, so was U 80. There was a push to "standardize" all insulin for people to be U 100 strength and that ended the sales of U 40 and U 80 for people here.

A lot of other countries have also gone with that standard, but there are still countries where you can buy all 3 strengths.

Some of the people I know who have diabetes and have been coping with it for 50+ years "remember when" there was U 40 and U 80 insulin on the market and wish they could still buy it. ;)

The syringe company is in MN and that state doesn't require a prescription to buy syringes; I never had to send them one. When I started ordering from this company, there were only U 40 syringes for pets and there were two sizes--a box of 100 1 cc syringes or a box of 100 1/2 cc syringes--no 3/10 cc syringes and no syringe disposer. :)

Kathy

[robertpri]

The site shows U40 syringes with 1 cc, .5 cc, and .3cc. Are these the marking graduations on the tube?

[We Hope]

http://petdiabetes.wikia.com/wiki/Syringe#U40_Syringes

A 1 cc U 40 syringe holds a maximum of 20 IU of insulin. A 1/2 cc U 40 syringe holds up to 20 IU of insulin, and a 3/10 cc holds up to 12 IU.

The 1/2 cc U 40 syringes have number markings going up by 5.

5-10-15-20.

They have a marking line for every unit. So you will see 4 marks before you get to the number 5 going up on the syringe. Then you'll see another 4 marking lines and the number 10.

They don't indicate that their 3/10 cc syringes are marked in half-unit scale, so I believe they are not. For U 100 insulin, when you buy 3/10 cc syringes, you can get them either way--marked for half-scale or not.

The only way the company sells their U 40 3/10 cc syringes is if you buy them with the disposal unit; my thought is that since they aren't marked for half-scale, it wouldn't be useful for you to pay the additional $ to get them--you would be paying for the disposal unit and not getting any more "advantage" to doing half-unit doses than you are on the 1/2 cc ones.

Kathy

[robertpri]

Many thanks. I guess the .5 cc makes the most sense.
Vet might have a supply, but I missed his sat close. He's there sun am.

more

just ordered 100 online--great, thanks!

[We Hope]

Just need to tell you they ship via UPS who may or may not leave the package if you're not home, so when you get some syringes from your vet, you might want to get enough in case you need to have UPS redeliver when you will be home.

[robertpri]

Just need to tell you they ship via UPS who may or may not leave the package if you're not home, so when you get some syringes from your vet, you might want to get enough in case you need to have UPS redeliver when you will be home.

I wish it was UPS! Those drivers know me [+ wife] and always took deliveries to the back door and left on the porch. They knew and understood.

FedEx is a wonderful service for business, but not too good for homes, at least around here. If you don't answer the door immediately, they are gone.

Worse, they leave the package on the front door, near the sidewalk and street. Three months ago, they left my $1,500 laptop on the porch and drove off. The box was clearly marked in bold letters, COMPUTER

Luckily, neighbor spotted it and held for me. I love FexEx, but not for homes.

"Shipping Information
UltiCare products are shipped directly to your home within 3 business days of ordering.

Our products are shipped via Fed Ex Ground. Fed Ex will deliver in 3-5 business days to most any location within in the Continental U.S."

[We Hope]

Boy, have things changed! When I ordered from them, it was UPS, and that was all! :D

[robertpri]

Seems like I am always "chasing" the test strips rather than a proactive plan. This am, Mik would not eat anything, but his ketones show trace to low again, and glucose still high. I gave him 1 IU and he reacted in a positive manner and then ate a weiner and some cheerios.

I want to get ahead of this, but can't overdose him on an empty stomach,

[We Hope]

Bob,

I think you said you have a vet appointment tomorrow and I would bring this up with him. Mik has shown trace ketones about 3 times in the last week.

Would tell him that it seems like Mik won't eat until he has had some insulin, and when he will eat, it's most often Cheerios and sugar-free hot dogs. You might be able to go over a plan with him which would let you give Mik a bit more after he has eaten something.

If it takes Mik less then an hour from the time he's getting insulin to eat, you should be able to add a little more without messing things up. An example plan would be:

AM--Mik eats nothing, gets his basal dose of 0.50 IU. Within the hour, he decides to eat well enough to get some additional insulin--let's say for the example's sake, he eats well enough to get 0.75-1 IU in addition to that. So his total morning insulin would be 1.25-1.50 IU.

You'd stick with the same thing 12 hours later--in the evening. If you can work out something like this, it would get more insulin to Mik and probably would stop the trace ketones from appearing on and off because he would be getting more insulin in a day, total, than he does now.

As he continues to eat better, he would be able to have more insulin to take care of the food.

It looks like we have to take the opportunities to get insulin into him when we can but with an eye toward making sure it works correctly and is safe for him. If we can think about trying something like this, it may mean it will get him feeling more like eating in the morning on a regular basis and possibly not needing to have the dose split.

There are some people who, out of similar necessity, will split their morning and evening doses of insulin. Example would be--the dog is to have 2 units of insulin twice a day. They give 1 IU before the meal and the second IU after it--doing this for breakfast and dinner.

We might have to take small steps, but when you add enough of them together and don't stop moving forward, you get somewhere. ;)

Kathy

[robertpri]

Many thanks, Kathy, as always, a wealth of information.

"If" and what a difficult word that has become, "if" I had any kind of regular schedule, I could make necessary adjustments.

I fully understand that all dogs require-and love-consistency, schedules, and repetition, and diabetic dogs much more so.

But alas, three days a week I'm up at 5 and outta here by 5:30. I have been able to give Mik .5 even when I have to wake him and on occasion, he will eat something. Depending on the amount, I increase to .75 or even 1.

But most mornings he is zonked out, so he gets just the .5

I can do the second shot around 5 pm, so that works.

On 4 days a week with no work, I wait until he puddles for a test strip and shows signs of activity, and can get some food into him. This is by 10 or 11 or so. The process is repeated about 10 pm.

I try to keep the 12 hour gap, but the start times vary depending on my work. I know that is not the best, and I'll discuss with vet.

thanks again

[robertpri]

The insulin certainly improves his appetite. No surprise to you all, but it's a wonder to see. I gave him 1.5 IU and then followed him around the house teasing with wiener bits. He finallly took some, so I carried him to the kitchen and he ate about 1/2 can of dogfood. I'm trying for more, but pleased so far.

[peggy0]

That's great!! 1/2 of a can is alot for a little guy. Good news Robert

[k9diabetes]

A good vet will work with what's possible even though it's not how things are supposed to be done. Hope your vet is a good one!! It's certainly worth discussing the situation and working together on a plan that will work for you, Mik, and your schedule.

Sometimes everybody has to be reminded that dogs don't read the books and just go with the plan! :) They have their own way of doing things and sometimes we are the ones who have to adapt!

Natalie

[robertpri]

Mik's back legs were giving him trouble last night so I gave him just 1 IU. Didn't want to risk it.

This am, it was the same, but he managed a small bowl of his new favorite.

Oddly enough, it's chicken and carrots and brocholli in some dog entree with good numbers.

Today at 2, he ate about a 1/2 can of the above, and another 1/4 can just now. I am trying to calc his 5 pm insulin. It would normally be 1.5 after a good meal, but not sure now.

vet tuesday

[We Hope]

Bob,

When you see the vet tomorrow, please mention Mik's back legs to him; it could be diabetic neuropathy from having such high bg's.

Agree with you about only 1 IU for this morning, but think the reason why you're not getting more into Mik tonight is because he's still pretty full from eating at 2 PM.

We want to get more food into Mik and also want to get more insulin into him too, but when you feed at times when you're not giving insulin other than to take care of a low, you can interfere with the action of the insulin and, as this evening, have a dog that's almost full when it comes to dinner and insulin time.

I believe I would only try for 1 IU tonight because we really don't know whether Mik has enough digesting to do on the 2 PM meal to keep his bg's away from hypo even with the addition of the 1/4 can at dinner.

Kathy

[peggy0]

Glad to see that Mik is chowing down at least :) Sounds like you picked the right one this time and I'm glad he is enjoying it.

[robertpri]

Agree with everything. When I get home at 2 and both are eager to see me, Mak wants to eat and Mik is enthused, so I feed him. Too rare to miss.

I plan on trying another feeding around 8 or so, and yes, I know he needs a continual schedule. But his appetite is so sporadic, that I take any opportunity where he shows interest in eating.

It is just too rare to get 1/2 can food into him at one sitting.

[peggy0]

Natalie, wasn't chris on a 3 times a day feeding/shot regime? I wonder if Mik would do better being fed and receiving his shots this way?

[We Hope]

Bob,

There are people who need to take the total amount of daily food and divide it up into 3-4 smaller meals. Some need to do this because of a previous bout with pancreatitis (smaller meals easier to digest) and some because the dog has quite a bad post-meal rise (smaller portions means less post-meal rise). Then there are one or two of the smaller meals where there's food but no insulin.

I believe you can do something similar to this, but you'll need to try planning it out. We would love to see Mik eat more in the morning so he can get more insulin then. Maybe if you made that 2 PM meal a small one, he'd be more eager to get the dinner one when you give him the insulin.

Am VERY glad to hear that Mik is willing to eat dog food because hot dogs and Cheerios don't make for a very balanced diet! :)

Kathy

[robertpri]

"...hot dogs and Cheerios don't make for a very balanced diet..." Really? I survived four years in college with that, plus beer. LOL

I would love to get more into him at 5 am, and maybe this new food might do it. Of course, he ate it for two days, so I bought several.

Translation: he'll hate it tomorrow.


If his am meal is puny, and the dose is .5, I would like to see him eat well later in the evening for a better dose. Then the smaller .5 am would be okay.


If I can get him to eat this same stuff, I plan on dividing into some kind of logical schedule.

Dumb question #467: what is enough? He's 10 pounds, so I kind of guess at 3/4 can per day. Sound right? I use that figure because wife told me about 1 and 3/4 for them both, and Mak is about 17 lbs so he gets a full can.

although he needs to lose some wt.

[peggy0]

Does it have the # of calories on the can?

10 pound dog………………………………………………………..300 calories is what our vet hospital recommends.

[robertpri]

Does it have the # of calories on the can?

10 pound dog………………………………………………………..300 calories is what our vet hospital recommends.

Hey, I'm about right! can = 420, and 3/4 of that would be ~300.

But mak at 17 lbs would be 420 or low, but he does need to lose.

Most of the other packages, etc, never state calories.

the package he likes says 12 oz [one pack] for middle aged or older 20 lb dog, but the same for eager, playful, rollicking puppy

So, by your vet, about 30 calories per pound?

[robertpri]

He gobbled up almost half a package, 6 ounces, which should be about 1/2 can so gave him a hair over 1 IU. He needs more, buy hypo scares me.

more

one hour after the 1 iu, he paced the kitchen so I gave him the other 1/2 package. Amazing

[BaileyBear]

Wow, sounds like you may have found a winner! Maybe his appetite is perking up a bit as he gets more and more insulin in his system, too. I hope he wakes up tomorrow AM and still loves that food enough to chow down and get his first full AM dose. Good luck, Robert! :)

[k9diabetes]

Hi Bob,

If you see this before the vet appointment, I reread your entire thread just now and I wanted to mention a few things to take up with the vet if you haven't already.

First...

Has your vet looked for a cause for the trembling, stumbling, and unwillingness to drink water?

Trembling in the front legs is not typical of diabetic neuropathy and taken all together these things could suggest some additional problem unrelated to the diabetes or the blindness. Other conditions that may be present but not obvious could also be a major contributor to the lack of appetite. You mentioned early on that you thought there might be a connection between the trembling and then refusing to eat. Certainly pain of any kind could be related to lack of appetite. Our dog went through long periods of refusing to eat things he normally loved when other issues were going on.

Second...

I would discuss the plan Kathy and I have suggested about forgetting about trying to get Mik to eat in the morning. To just give him 0.5 units of insulin and skip trying to feed him. Then wait until 5pm or 6pm and give him dinner and insulin.

I know he's hungry at 2pm... if you do not feed him at 2pm, leaving him hungry, do you think he would reliably eat dinner around 6pm?

Mainly, I would like you to ask the vet to help you devise a plan that you think Mik will generally stick with. And that it should probably be based on one meal a day in the afternoon or evening with insulin only in the morning in a small amount and food and a larger amount of insulin in the evening.

Third...

Although I rarely suggest a fructosamine test, this might be a case where it would be useful. Seeing what he's been eating and how much insulin you have been giving, a fructosamine would give some suggestion of his overall glucose control this past couple of weeks working things the way you have been. It would be a bit more informative than the urine tests can be.
________

It's really not necessary to have food go with the insulin as long as the insulin is in a small quantity - like the half a unit you have been giving. So I see no reason to fight every morning to get him to eat. Just wake him up, give him his half a unit, and go on with the day. Then come home and give him a 6pm meal like he's used to and a larger dose of insulin.

After all, life is short and I hate to see you two spending all of your time fighting to get Mik to eat.

And I would consider the possibility that there is something else contributing to the stumbling and appetite problems.

Wishing you luck and a productive appointment tomorrow! :)

Natalie

[peggy0]

they quote it by every 10 pounds but I would say that's a safe rule

[k9diabetes]

Chris, when he felt well, was always willing to eat! So at one point he was on NPH three times a day and got a meal with each injection. Later he went to Regular four times a day and got a meal with each injection then too. We never gave meals between injections.

His last nine months when he was not feeling well, he often would not eat.

Fortunately, by then, I knew how much insulin I could give him if he didn't eat anything and that's what we did. He got insulin and no food. This worked very very well for him. We would try to find something he would eat and if he wouldn't we went with the no-food dose and tried again at the next scheduled meal.

[robertpri]

Vet moved to Wed--he had afternoon surguries, and I didn't want the second vet with no previous with mik. But we had a good talk on the phone, and he agrees with several ideas from here--we chat wed

meanwhile, mik got .5 this am on empty tummy. Came home at 2 and tried to play with both dogs until around 3

mik ate 1/2 pack [6 oz of good food, plus 1/2 jar baby food--chicken

gave him 1.5 IU, then watched closely, and one hour later, he ate the rest of the pack [6 oz] plus almost a cup of blue buffalo kibble! Happy happy!

waiting for puddle to test

[We Hope]

Bob,

This sounds GREAT! :D

I don't blame you for waiting for your vet who knows Mik well. We made a rule that everything to do with Lucky except taking blood went through John.

If Mik can keep eating like this, we are getting somewhere! :)

Kathy

[peggy0]

Wow! His appetite is surely back. You've reached the gourmet chef stature in his books :) I'm so happy you're having luck with this new food Bob. Looks like he's on his way

[Fishslayer]

Good news! Hope he keeps his appetite.

Rick

[BaileyBear]

Wonderful! Sounds like he is feeling a lot better as he gets more and more food and insulin in there. You must be so relieved! :D

How about Mak - how is he doing?

[robertpri]

Wonderful! Sounds like he is feeling a lot better as he gets more and more food and insulin in there. You must be so relieved! :D

How about Mak - how is he doing?

Heh, Mak is reaping the rewards of all these feedings. I need him to lose wt, but kinda tough while feeing Mik over and over.

So, I reduce his portions dramatically, but then he stares at me, like only a dog can stare.

Healthwise, no real change, of course, this kind of heart disease does not go away.

thanks all!

If I've had any success, I owe it to you people....

[Margaret Boyle]

Heh, Mak is reaping the rewards of all these feedings. I need him to lose wt, but kinda tough while feeing Mik over and over.

So, I reduce his portions dramatically, but then he stares at me, like only a dog can stare.

Healthwise, no real change, of course, this kind of heart disease does not go away.

thanks all!

If I've had any success, I owe it to you people....

Glad to hear Mik is a lot better Robert :)

LOL

[peggy0]

How are our Mik and Mak doing today?

[robertpri]

Mik not doing well. Long session with Vet, and his BG is around 500. We discussed Mik's lack of appetite for a full day, then eating well once. The good food he loved two days ago is now radioactive to him.

Vet wants those BG's down, so will increase morning from .5 to 1 IU, and increase evening from 1.5 to 2.

His appetite only seems improved after an insulin boost, usually 1-3 hours later, so will try this.

I am at home for 4 days now, so gave him 1 this am, and hoping to see him eat before the pm shot.

Peaks and valley's eh...

more

Mik has lost about 3 oz in about 3 weeks which considering what he has been through, pleased the vet. He is more concerned about reducing the BG's that wt for the immediate short term. Mik tends to eat more after the vetsulin, so I need to increase it.

[We Hope]

Bob,

We all knew Mik needed to have more insulin than he was getting. Hoping that the increases will mean Mik's appetite will be better!

Kathy

[robertpri]

What causes pet diabetes? I figured it was poor diet, but Mik has never eaten anything but vet-approved food, no table scraps, nothing.

And filtered water

[eyelostit]

From everything I have read, it may have came from a virus, the use of steriods, an illness, hereditary.

All I can remember with Niki is that she was walking with her backend hunched up, vet gave her an enema, now I think she may have given her a steriod drug, I can't be positive, but if so I would think that did it, maybe that was the start of it, a bit after that she started to leak urine.

Weird thing is my Chief got Cushings 3 yrs later, I just can't understand it anymore, could be the dogfoods a number of things.

Since this happened I always keep track of the medicines for the dogs, we all wish we could go back at times, but darn theres not anything I can do now, I still think about it.

Hopefully down the road someone will find a cure for canine diabetes.

[peggy0]

Forbin never had any meds prior to his diabetes. He lived 9 years with no illness, no need for even an antibiotic. when they asked what he was allergic to, I couldn't tell them. He had premium dog food his whole life. I never worried about it until the nutro recall. When 3 dogs walk away from the food they've loved for years, there's a problem. i often wonder if that damaged him somehow.

I also think they are vaccinated way too much. I changed to 3 year series vs. annually years ago.

[robertpri]

Lord, I don't want to think it was steroids, which would mean I caused it.

I almost lost Mik after wife died last year. Always sensitive anyway, he went into depression that only a pet lover would recognize. Would not eat, just stay in bed all day, and developed some kind of pneumonia.

Almost died from the massive liquid in his lungs. A deep cough and hack that was so loud it woke me. I would hold his trembling body for hours.

Vet wanted him on Lasix for the water retention, and I had to force them down, but he was wasting away. Vet put him on steroids for appetite, and they worked!

He gained back most of his wt, and after two months of hell, finally recovered. It was about a two months later that this diabetes surfaced.

Jeez, I feel terrible thinking I might have cause this, but at the same time, I know he would not have made it during the bout with pneumonia.

[k9diabetes]

Bob,

Steroids most likely kicked off Chris diabetes... but what was the alternative? Sometimes you have to use them to save their lives.

Plus diabetes is also a very common disorder in dogs and as an autoimmune attack there doesn't need to be anything to "cause" it. It can happen all by itself.

It's different in cats - diet definitely does play a role for them - but not in dogs.

Natalie

[robertpri]

Low breakfast + 1.5 IU
Medium dinner + 2.0 IU

day total, 3.5, which is 1.0 higher than any day.

Mik's blindness remains an unsolvable problem, but he is getting slightly more confident so he moves faster. Ergo: when he collides, it's much harder.

Spent the afternoon taping bubble wrap to desk sides and door edges where he hits the most.

more

after medium dinner and insulin, Mik ate two jars of chicken baby food, a cup of cheerios, and a 1/4 can of Skippy dog food! Now, if we can sustain that with real food--but at least it's calories.

[BaileyBear]

The bubble wrap gave me such a chuckle! :D You're such a good "Dad" trying to soften the blow of things he knocks into. Sounds like he is feeling more confident and adjusting well. Glad to hear his insulin is increasing. Hopefully you'll be able to move to more of a feeding schedule as his numbers come down and his appetite continues to improve. :)

Bailey was never on steroids or had any major illness before the diabetes diagnosis - just ear infections. He was only slightly overweight and that happened during the months leading to his diagnosis. We suspect he was just eating more to keep up with the demands on his body and increased hunger as the diabetes set in. Since he was a free feeder and always had it available to him, he never lost weight like many dogs. His vet seems to feel his diabetes was autoimmune and that there was nothing we could have done to prevent it and nothing we did to cause it. He was glad he had a little extra padding while we were working on regulation so we didn't also have to worry about weight lose when he was feeling cruddy.

You can't beat yourself up for it - who knows what lead to diabetes in Mik? Even if the steroids contributed, they were recommended and needed at the time. You took him to the vet and had him treated for the problem he had at that moment. You did what any responsible pet owner would have done.

[eyelostit]

I can just see you with the bubble wrap :), don't beat yourself up, we all do the best we can when our doggies are sick.;)

[robertpri]

I can just see you with the bubble wrap :),

The very first time Mik "charged" through his little space, he hit the bubble wrap and bounced back, stopped, sniffed the stuf a long time, bewildered, and you could just see him saying, "'What the...?"

[k9diabetes]

Heheheheh.... I guess Mik didn't thank you, huh?