Poppy - 13yo Jack Russell - has passed

[drew.h]

I’m from the UK, specifically the Lake District (Cumbria). We have three Jack Russell dogs at the moment, Taz, Ginger and Poppy. Taz is the father, Ginger and Poppy his daughters. We lost their mother two years ago to cancer, although I believe that it is possible this was misdiagnosed and she could have had diabetes as well.

Poppy takes very much after her mother and was diagnosed with diabetes about 6 months ago, she is now coming up to 13yo. She is also blind, which doesn't affect her to much, on a good day she can even play fetch.

We have been able to easily control her diabetes up until 6 weeks ago, likely to be the first time she has been in season since the diabetes. She is now rarely moving from her bed, drinking lots of water, vomiting a lot and won't eat.

First time she was very bad and spent two nights in the vets on a drip. I am not happy with the vets at the moment (one in particular has misdiagnosed problems in two of our horses and caused them suffering). The vets say the problems are down to her being in season or perhaps cystitis. Our dog was only interested in her for two days and blood was only passed 4 weeks later. She missed her last season (her sister was spayed last year, which may have put her out of sync), hence not having her spayed before.

The insulin they prescribed is Caninsulin. Before the problems I was injecting her once per day with 15 units, now I have split to twice per day, 10 units each time. The urine tests strips are showing zero to medium glucose (can't distinguish a pattern at the moment, unlike before). Her ketone level was related to how much she had been vomiting (zero to very high), but now appears to be a constant low, but still traceable amount.

I'm wondering if anyone else has had a similar problem?

[We Hope]

Welcome!

First of all, since Poppy has not been spayed, you are having some issues because of that. Progesterone, one of the female hormones, is part of what's called the counter-regulatory hormones which drive the blood sugar up when one hits a low. When there's an excess of it for any reason, it will make them go higher.

I am also wondering if Poppy has been checked for any infections--urinary or female-related especially. Diabetics tend to run infections of all sorts much easier than those who don't have the disease; the urinary tract is one of the places they settle into because of the sugar in the urine. Having that in the bladder can be a breeding ground for infections. Infections of any kind generally make the bood glucose go higher, but they can make them go lower too. If you think about when you're not well, you can either have a fever or have a lower than normal temperature--the same for blood glucose levels.

Another thought I am having is that the total of 10 units of insulin twice a day, equalling 20 units, may be too much insulin for Poppy. What can be happening here is that she is rebounding.

This happens when there's too much insulin; the excess insulin takes the body to a low. When it gets to the low, the built-in fail safe mechanism we all were made with--the counter-regulatory hormones--are activated. Their job is to try to save the body from going into hypo and they send the blood glucose up, most of the time into very high levels.

What happens in this is that it's like bouncing a ball--the harder you throw it to the ground, the higher off the ground it bounces back. In this case, the only way to stop the ups and downs is to give less insulin so there are no lows created, because they are the ones who make for the highs and more insulin will not solve it.

I would think Poppy might do just as well on getting 7.5 units of insulin twice a day, 12 hours apart, as she did with having 15 units once a day. Have you another vet in the area you could consult with for Poppy?

Please tell us more about your Poppy--we'll do our best to help! :)

Kathy

[drew.h]

There are other vets I can go to, although they are much further away (about half an hour drive). I'll phone them both on Tuesday and see if either have diabetic specialists. Unfortunately most vets around here tend to be trained for large/farm animals.

I did think about the insulin level being to high and had tried dropping it back to 15 last weekend, but the glucose levels came up. Because she has not eaten much yesterday I have reduced to 8 last night and 8 this morning.

An infection was a suggestion by the vet, but only after I press the vet, because I didn't feel the she was still in season. She was given a course of antibiotics tablets, but I am not sure how effective these where due to the vomiting. Injections would have been a better option.

I have not been able to feed her anything today, tried everything, chicken, egg, bacon, liver. May have to force her later. Last time a little jam helped give her an appetite.

A little more history to Poppy: She was the runt of a litter of 7 and had to be revived twice shortly after she was born. She is very intelligent, knows the names of all her toys (will fetch the one you ask for, even blind), plus names of several insects and household appliances (least favourites being spider, slug, Hoover and Dyson). Being highly strung, she has bitten 4 people in her life (including the postman and sons girlfriend), all on our property and our fault, but just the one little bite before running back in the house for re-enforcements.

[We Hope]

One of the problems with a lot of antibiotics is that they give problems with the GI tract--can cause nausea and/or vomiting or problems with the bowel--diarrhea or constipation. It can happen whether you get them by mouth or in a shot, but when you need to use them, there isn't much choice.

Now--you are saying you needed some jam to get Poppy eating. I am wondering here, since you have no glucose showing on her urine test stick, if Poppy isn't having a low and needs some sugar.

http://www.pet-diabetes.co.uk/hypoglycemia-dog-diabetes.asp

"Signs of low blood glucose

"Low blood glucose can be fatal, so it is extremely important that you recognize these signs, which are often subtle in the early stages:

restlessness
trembling or shivering
unusual movements or behaviour - some animals become very quiet and stop eating.
muscle twitching
coma

"What to do

"If any of the above signs are present, you will have to react quickly.

"Provide food immediately.

"If your dog refuses to eat, administer a glucose solution immediately.

Glucose solution can be made from glucose powder and tap water. (It is wise always to keep a small amount of glucose solution ready for use.) One gram of glucose per kilogram body weight should be given (1 teaspoon per 5kg).

Administer the solution carefully into the cheek pouch. Only do this if you are sure that your pet can swallow. Give the solution very slowly to avoid choking. A clean syringe is useful for administering glucose solution.

If your pet is unable to swallow normally, rub the glucose powder into the gums (especially under the tongue). BE CAREFUL THAT YOU ARE NOT BITTEN. If glucose is unavailable, use jam or honey.

As soon as recovery is evident, give your dog a small amount of food. Then keep an eye on your dog for several hours to ensure that the signs do not return and contact your veterinary surgeon.

If your dog's condition worsens (muscle twitching, unconsciousness) or you are unsure, call your veterinary surgeon immediately."

You can have a problem with a dog eating when the blood sugar is either too high or too low. What makes me suspect Poppy is going too low is that she rallied when you gave her the jam and that her urine stick test for glucose is negative. All we know when we arrive at a negative urine test is that the dog is somewhere under what's called the renal threshold--about 10 mmol. We don't know if he/she is too low and we can't know without testing the blood to get a more accurate result.

I'd do as the Caninsulin page above suggests and see if Poppy does better--when you have a problem and giving something with sugar in it helps, then I surely would think this is a low she's having. Lows need to be handled quickly because they can hurt or kill much faster than high bg's without more than a trace of ketones can.

Please keep us posted as to whether this helps Poppy!

Kathy

[eyelostit]

Hi Drew & Poppy !!

Welcome

I think Poppy will do better also on the Insulin dose 2 x day. Alot of vets do this once a day thing with vetsulin but on the vetsulin site it is being said to do two injections per day, I'm pretty sure I have read this there.

With urine testing even in the negative area you cannot tell how low Poppy's BG is going.

I home test Niki with a blood glucose meter, I use a human meter and a pet meter.

We have some members from the UK here also, home testing is the way to go, you can actually see your pets bg levels and how the insulin is working. This way less visits to the vet, did your vet ever mention doing a curve on Poppy?

Again Welcome :)

[k9diabetes]

Setting aside potential problems from the hormones and possible infection for a moment, my first thought also is that 10 units twice a day is too much insulin.

It sounds, if I'm understanding you properly, that you had pretty good control on 15 units once a day. I'm guessing you went up because of her possibly being in season and/or having an infection but then stayed at the new level of insulin after feeling like her hormone levels had returned to normal.

Has the vet ever done a curve of her blood glucose while she was on 15 units once a day? On 10 units twice a day?

Although it's rare, a very few dogs can get by on once a day insulin only. More often they need a smaller dose of insulin twice a day. So she might have needed 7-8 units of insulin twice a day to replace 15 once a day if the issue was just that one injection did not last long enough.

I would cut her insulin to 7-8 units per injection, two injections a day and leave it there for four or five days as long as she doesn't start throwing more ketones than a trace.

If the 10 units twice a day has been causing rebound, it will take time at a reduced dose of insulin for her to recover from that. You can see blood sugar that is unusually high all the time or bouncing around for as much as three days after a rebound episode.

So you want to get her unquestionably out of any possibility of low blood sugar for four to five days and only then decide whether the new dose is enough.

Have you considered testing blood glucose at home?

This would help you immensely just in knowing what is actually happening with Poppy. You would be able to see whether rebound is involved. A curve is definitely needed and if you learn to test at home you can do it yourself.

You can see video and picture tutorials of how to test at www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html). We have a handful of members from the UK who are home testing now and it's the kind of tool that once you get started you wish you had been home testing blood sugar from day one.

Take a look at information on rebound just so you understand the theory behind it.

www.k9diabetes.com/monitoring.html (http://www.k9diabetes.com/monitoring.html)

http://www.caninsulin.com/Somogyi.asp

What isn't always mentioned is that a single bout of rebound can skew the blood sugar for that two or three days afterward. So you have to basically ignore the high or crazy BGs you see (again, as long as ketones are trace) and just wait out those days for things to settle down. After some time has passed, you can look at the blood glucose response and rely on that information to make decisions.

Natalie

[BaileyBear]

Lots of good advice given - just wanted to welcome you and Poppy. I have no doubt that the very knowledgeable folks here will help you get Poppy's numbers back down. Glad you found your way here and look forward to learning more about Poppy...and Ginger & Taz. :)

[drew.h]

Vet hasn't mentioned doing a curve, which is another reason why I'm thinking a better vet is needed.

I gave her 7 units last night and this morning, yesterday morning and the previous evening she had 8 units each. The urine test strip is showing slightly higher glucose level and still a trace of ketones. From what the vet said the test strips are an indication as to the levels about 12 hours ago.

I tried the jam just as precaution when she had not eaten for a while after giving an injection. I didn't want to risk her blood sugar going to low.

She still is not eating, any attempt to feed her causes her to vomit the water she keeps drinking. Although when mentioning one of her toys before she lit up, its the most enthusiasm I have seen from her over the past few days. I'm going to take her out in the sun now and see if I can work up an apatite in her.

[We Hope]

I'm hoping you will get Poppy in to see some vet because right now, it's not clear that her problems are directly diabetes-related. If, for example, Poppy does have some type of infection, that infection can be what's causing problems with her bg's; infections are a common reason for regulated diabetic dogs to suddenly "lose" their regulation.

If it is an infection, treating that will get the bg''s back into normal line.

When you test urine for glucose, the results you get also depend on how long the urine has been in the bladder; there can be some very high results when testing the first morning urine. But if you were to test the blood for glucose with a meter, you would probably see a different set of numbers because the blood shows how much glucose is in the body right now. Urine testing shows what was there 2+ hours ago.

Poppy needs someone to have a good look at her because you need to find out what's causing her not to eat. As long as you say most of your local vets don't deal much with small animals with diabetes, the good news is that any one of them you might trust can contact Intervet for advice in dealing with diabetes issues and problems.

Intervet has diabetes specialists on staff who will answer questions and help local vets with their diabetes cases:

http://www.noahcompendium.co.uk/Intervet_Schering-Plough/Caninsulin/-28705.html

Company name: Intervet / Schering-Plough Animal Health
Address: Walton Manor
Walton
Milton Keynes
MK7 7AJ
Telephone: 01908 685685 (Customer Support Centre)
Telephone: 01908 665050 (Switchboard)
Fax: 01908 685555
Email: support.uk@intervet.com
Website: www.intervet.co.uk

Their website for people with diabetic pets has a lot of information on it. Here's the main page for diabetes in dogs:

http://www.pet-diabetes.co.uk/diabetes-mellitus-dogs.asp

http://www.pet-diabetes.co.uk/blood-glucose-dogs.asp

The link above is about glucose curves.

In order to start eating and feeling better, Poppy does need to see someone as soon as you can get a vet to have a look at her.

Kathy

[k9diabetes]

Haven't had a chance to look... has she ever had pancreatitis?

This continued vomiting means she needs to be seen right away by someone who will take this seriously. Not only for diabetes-related issues but other things like pancreatitis...

I'm worried about Poppy and hope she saw a vet today.

Natalie

[drew.h]

Vet opens in one hour. I'll ask for the main vet.

Did get a little food down her yesterday, but she isn't getting any better.

The only the other thing she has had wrong with her is a mammary lump. Its smaller than the one her mother had and hasn't increased in size in the past year. When she first started being ill (about 8 months ago) we thought it was cancer, the same as her mother. She had the same symptoms her mother had. Vets did a biopsy on her mother and found an aggressive cancer. We have shown the lump to the vets, but they say its nothing to worry about and just to keep an eye out for any change. Poppy is now showing the same pattern of symptoms her mother had before she started fitting and we had her put to sleep, hence now thinking her mother had diabetes.

I'll let you know how we get on.

[drew.h]

Bad news.

Took Poppy into vets this morning, vet took some blood for analysis, gave her some fluids and antibiotics. This time vet believes she may have a tumour in her pancreas.

Poppy was getting worse, she could hardly stand and was having difficulty even drinking water. Kept phoning vets to check if her blood test had come back. Eventually it did, but vet said it was bad news. Very high levels of enzymes from pancreas and kidneys. Vet says her kidneys are closing down and she hasn't got long. It was apparent she was suffering, so the decision to put her to sleep was quick.

Poppy is now resting with her mother. We will miss her.

I had just opened a new box of Caninsulin 40UL yesterday, the used vial has been disposed of, but the rest may be of use to someone. If anyone wants it please PM me, but you must be in the UK and able to collect from post code LA11 7LQ. I doubt the vets are allowed to accept it back. I'll keep it in my fridge for now. If no one wants in soon I'll try the animal sanctuaries.

[We Hope]

I'm so very sorry that you've lost Poppy!

The Last Battle
If it should be that I grow frail and weak
And pain should keep me from my sleep,
Then will you do what must be done,
For this -- the last battle -- can't be won.
You will be sad I understand,
But don't let grief then stay your hand,
For on this day, more than the rest,
Your love and friendship must stand the test.
We have had so many happy years,
You wouldn't want me to suffer so.
When the time comes, please, let me go.
Take me to where to my needs they'll tend,
Only, stay with me till the end
And hold me firm and speak to me
Until my eyes no longer see.
I know in time you will agree
It is a kindness you do to me.
Although my tail its last has waved,
From pain and suffering I have been saved.
Don't grieve that it must be you
Who has to decide this thing to do;
We've been so close -- we two -- these years,
Don't let your heart hold any tears.

-- Unknown

Kathy

[Squirt's Mom]

I am so sorry to hear about your sweet Poppy. We are never ready to lose one of our family members, as surely all our babies are, and the pain cannot be made less by simple words. But know you are thought of as is your Poppy, wishing you peace and comfort in the memories.

A candle has been lit for you and Poppy at http://www.gratefulness.org/candles/candles.cfm?l=eng&gi=ccnet. You are welcome to light one for her any time you wish.

Our sympathies,
Leslie, Squirt, Ruby, Goldie and Crystal

[Patty]

I have been following your posts on Poppy and am so very sorry for your loss.
My condolences,
Patty

[Cara's Mom]

I am so sorry that you lost Poppy. My thoughts are with you.

God's Speed, Poppy.

Hugs,

[eyelostit]

I am so sorry for you and your family.

[BestBuddy]

I haven't posted before but I have been reading along. I am heartbroken for you and your family.
Godspeed Poppy
Jenny

[BaileyBear]

I'm so very sorry to hear how the tests came out and that Poppy has passed. My heart goes out to you and your family.

[ladysmom06]

I am so very sorry for your loss of Poppy. You and your family are in my thoughts and prayers.

[bgdavis]

I'm so very sorry for your loss of Poppy. This spring sure has seen many of our furbabies making the trip to the Rainbow Bridge. Kidney failure is one of those things we can do so little about.

Bonnie and Angel Criss

[Daisy's Mom]

I am so sorry for your loss of Poppy. You did the right thing to end her suffering.
These little characters are meant to be healthy and happy and not to suffer.

I pray you can smile again soon in your happy memories of
your darling girl.

Sending you a big hug across the pond.
XOXO
Lisa :o

[k9diabetes]

Oh Drew.... I was very worried that something was horribly wrong with Poppy and I am devastated to read that you had to let her go. It is especially hard when there is such a rapid decline.

Although I've only met you recently, your love for Poppy and her canine family is obvious - what a blessing that they came to you to care for them.

If you would like to post the story of Poppy and her mom, we have a Stories Forum and would be honored to have Poppy and her mother memorialized there.

Sending my deepest sympathies,

Natalie

[Margaret Boyle]

I am so sorry for your Loss Drew I did not know you but that makes no difference Poppy is at rest now and free from pain.

God Bless

[angelbudsmama]

Hello...I seldom am able to get to this forum due to time constraints, but try to read up when I can....I lost my Bud ( rat terrier) 8 weeks ago, and I want you to know I am so sorry for your loss. It's never easy losing a beloved pet. I read Poppy's story, and want you to know you are in my thoughts and prayers during this sad time.....You did the best you could, and the right thing.

Blessings,
Judy, Angel Bud and Harley in Arizona.

[Baxtersmom]

I am sorry for your loss.

[janspack]

I am so sorry. May the happy memories soon overtake the sadness.