Marianne's Pebbles - In Hospital TA&M 10/20

[We Hope]

More from link above--this is their advice for people who need to give themselves injections--

"Most people pinch up a fold of skin and insert the needle at a 90° angle to the skin fold. To pinch your skin properly, follow these steps:

"Squeeze a couple of inches of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle. (If you use a 5 millimeter mini-pen needle to inject, you don't have to pinch up the skin when injecting at a 90° angle; with this shorter needle, you don't have to worry about injecting into muscle.)

"Insert the needle.

"Hold the pinch so the needle doesn't go into the muscle.

"Push the plunger (or button if you're using a pen) to inject the insulin.

"Release the grip on the skin fold.

"Remove the needle from the skin.

Sorry--am getting Internal Server Error again when a post is a little long--need to split this.

Kathy

[k9diabetes]

This diagram is at BD's site. I originally injected Chris in the scruff but found the skin thickend there very quickly. So fairly early on I switched to the side about 2/3 of the way up the ribs just behind the front leg.

http://www.bddiabetes.com/resource.aspx?IDX=2551

Basically, almost exactly where the arrow marked "Side of Chest" is in the diagram is where I injected Chris for the past four years.

Little things made a big difference.

Especially on his right side, there were lots of angles and places that made him flinch. Could do the same on the left side and it wouldn't bother him.

And whether I faced the needle forward toward his head or backward toward his rump affected the comfort of the injection. He didn't like them pointed backward. I think the right side problems were also at least partly connected to handedness. I gave injections with my right hand and it was harder to do on the right side. Harder to get a good angle.

I used the short needles as Chris' skin was fairly loose and not very thick. I didn't do an elaborate tent. Just pulled up a spot that was loose, stuck the needle all the way in since it was short, and plunged. Angle varied.

They all have their quirks and unfortunately only experience can tell you what Pebbles will and won't like. But don't be afraid to experiment so you can find out what works best for her and you.

I always gave Chris' injection while he was sitting but in the last few weeks he didn't want to sit so had to give them while he was standing or lying down and I found that a lot more difficult. It pulled his skin tight.

[rhodesian46]

Thanks guys!!!
I found some .3 cc 31 gauge 5/16 inch syringes I usually use 29 gauge 1/2 inch 1 cc. I know that in order t do 42 with the .3cc syringes I will have to draw 30 then another syringe of 12 Adding up to 42 u. Thought I might try this tonight as maybe the 1/2 inch is too long to go on her side If all works well in the next couple of days I will buy the shorter needles in 1 cc 5/16 inch 31 gauge. And yes I hurt her this morning again and lost some insulin as well She will be running high today What do you guys think? Keep in mind tat Pebbles skin is thin because of the cushings Poor baby She hates me know and runs Mama is killing her!!! BTW she loves her 1 1/2 tbl BID of pumpkin!! I wrapped them in individual wax paper and put in tupperware and froze One cans last a week THats Ok if this works its well worth it. With Halloween coming soon how would you fix it from a pumpkin!! It may be more reasonable to buy some. Will let you know how 2 injections go tonight
Marianne and Pebbles
.

[eyelostit]

i can't do a right side even at scruff, has to be near the middle or to the left, for awhile i was doing a 90 degree above her shoulders until her scruff lost those lumps from injections.

Sometimes it just bothers her and she scrunches down telling me "I don't like it" so then I tell her to lay down, it seems I can get more fat that way.

Niki doesn't have alot of fat, i imagine most diabetic dogs don't.

[rhodesian46]

Also Pebbles has thin skin from her Cushings. I guess I just gotta do it and not be afraid I can easily go back to the scruff but I feel that this area would be better absorption I think since I hurt her for the past 2 days that she is leary of me and the needle. Does Niki squeal? Pebbles eyes almost bug out!!!:D:D

[eyelostit]

Sometimes she will do a little cry, I feel so damn bad when that happens, but lately once i go to insert the needle a little she does this hanging of her head or scunchs down a bit, she knows to hold her head up and usually does but if I go to an area she don't like she does this, but sometimes I can get the needle in, start to push on the insulin and she will wimper so I have to pull it out and do another spot.

I have never tried the other areas, other than under her skin above her shoulders, I guess I am nervous about it with a new spot and it affecting her readings and I'd be a basket case all day!!

Maybe if Pebbles lays down you usually can get more fat at the scruff then.

[Denise]

Marriane, this months Animal Wellness magazine talks about using colloidal silver for skin issues. Mentions some nasty cases that cleared right up. If I could get my scanner to work I could send the article to you! argh!

[k9diabetes]

How are the injections going?

[Ricksma]

Marianne, Several years ago, when we found out Butchie was diabetic, the vet told me to inject at the scruff. We were pretty much flying by the seat of our pants back then (about 16 years ago), and Butch and I were both uncomfortable with the scruff. So, for about 4 years, I held his head under my arm, and injected into his rump area. I just pulled up some skin, and injected on the sides of his butt. He never seemed to mind, but now I wonder what the absorption was like being injected in that area. We must have done something right...he lived almost 10 years with diabetes.

Love and hugs, Teresa and Ricky

[rhodesian46]

That is amazing Teresa 10 years You should be commended for your dedication!!!! Natalie the injections are going Ok I guess Picked up some 1cc 5/16" 31 gauge syringes at Wally Mart Sat Her bgs have been great Was a little worried(but not complaining) her Bgs 4 1/2 hours after I fed her was 124 on One touch ultra meter So probably 165 or so I was afraid that since since goes lower 8 hours later that she would go too low and I would be sleeping! I gave her a 1./2 of a baby milkbone Didn't test this morning as I was a friggin zombie at 5:30 am Shot went well No screaming. Am alternating Left side right side Her skin infection is better Still on the antibiotic Great bgs Not complaining She is eating thank the lord.Really don't need any more vet bills She will need to go for her stim in Oct So I need to get ahead Pebbles loves her frozen pumpkin I put 1 1/2 tbl in wax paper and freeze She gets one with each meal. This dog will eat anything!!! I stopped the Metamucil I can lasts me a week. Its pricey here Libbeys can is $1.32 at Wally Mart Will keep ya'll posted I injected Pebs tonight and she screamed!!! Had to insert needle 5 times in her I can feel her twitch when I inject Does that mean that she hurts or is that she is nervous Shoot I don't know Just when I gain confidence I then kill her!!!

[rhodesian46]

Ok I have decided( Natalie helped me with this decision today) to stop hurting Pebbles I lost my patience today as it was 5 :30 am No coffee,she was screaming 6 times that I injected her side We were in a laundry room and I yelled at her and forced her to stay put. So I have damaged Pebbles for life as she will never let me inject her in the side again!!! Messed up her mind for sure. She is going to have nightmares now!!!Am going to give this a break as she doesn't like it and I hate as well I literally sweat doing this. I am sick of fighting with her and feel bad that I am hurting my baby We are going back to the scruff for now I will see how her Bgs are this week as I will need to do a curve this Sun to send to Dr Bostrom All went well with the injection Yeah in the scruff of course!!!!:D:D:D
Marianne and Pebbles

[BestBuddy]

Hi Marianne,
Pebbles will forgive you. I also tried different spots on Buddy but it was the same as you, he screamed and cried and I just couldn't do it anymore. We have been using the scruff for over 6 years now and it looks like that will not change. I do try to move the injections around on his tiny scrawny neck and yes the skin has thickened a bit but no lumps and the insulin is still being absorbed. Don't feel like you have failed just think that you have learned something.
Jenny & Buddy

[We Hope]

Ok I have decided( Natalie helped me with this decision today) to stop hurting Pebbles I lost my patience today as it was 5 :30 am No coffee,she was screaming 6 times that I injected her side We were in a laundry room and I yelled at her and forced her to stay put. So I have damaged Pebbles for life as she will never let me inject her in the side again!!! Messed up her mind for sure. She is going to have nightmares now!!!Am going to give this a break as she doesn't like it and I hate as well I literally sweat doing this. I am sick of fighting with her and feel bad that I am hurting my baby We are going back to the scruff for now I will see how her Bgs are this week as I will need to do a curve this Sun to send to Dr Bostrom All went well with the injection Yeah in the scruff of course!!!!:D:D:D
Marianne and Pebbles

Marianne,

The first thing is to give Pebbles her shots where you're able. Going back to the scruff doesn't mean failure--it means do it the way it gets done and take a break from trying other spots. If you want to try other spots again, let some time go by before you do.

Pebbles won't hold a grudge; Lucky forgave me for pinching and trying to pull his skin into a tent. He forgave me enough to come into the kitchen for his shot and treat after his meals. He also forgave me for when he needed Pepto Bismol and that was a fight like no "shot match" ever was. :D

Take it easy on yourself--Pebbles is doing super and you're the one who makes that happen!

Kathy

[eyelostit]

Brave girl Marianne !:) Sorry it didn't go well, I have gave it some thought to try on Niki, but I am just afraid to do it, I think after 6 yrs she is damn tired of the shots and the testing, but the other poster had mentioned the rump, so thats uptop her butt right?

I'm still hesitant about it, usually if Niki gets finicky I make her lay down and like I said then there is more fat.

[Dollydog]

Hi Marianne,
I'm sorry the other spots didn't work. There's not enough skin on Lady for me to try anywhere else but the scruff and her back, just behind her shoulder blades. I have 4 spots and do them in rotation...right scruff, mid scruff, left scruff and then the back shot. The most sensitive is the mid scruff as it was the place I used for a couple of months when we first started the injections. Lady will raise her head from her food cup if I get ahold of a sensitive spot there and then I have to move one way or the other to give the shot.

We've been at this over 19 months now and it's amazing what I still have to learn about it all. Lady will tense up if I hold my breath so I have to remember to breath normally....which is hard to do if I haven't had my first mouthful of tea in the morning!!! I don't even attempt the shot without that first mouthful!!
Jo-Ann & Lady :)

[rhodesian46]

Weighed Pebbles this week She is still 55.4 lbs and has been holding this weight for 2 weeks now, I have an appointment Oct 7 to see nurse Rachet( nickname for Dr B) She
comments on Pebbles bacteria skin infection as it hasn't gone away She has been on the antibiotic for over 2 weeks now, She asked when her T 4 was done I told her it was there at A & M on 4/16/08 It was 3.57 She is on .5 mg bid of Soloxine She says
"If there is no inflammation (redness, heat, oozing, pustules, etc)
associated with her skin lesions then it is more likely to be associated
with her endocrine diseases.

I think we should do T4, stim test, chemistry with electrolytes, and a
urinalysis."
Meanwhile I went back to injecting Pebbles on her side I do this while she is eating SO far so good She hasn't screamed just gets nervous Eating is way too important for her! Did a curve Sunday Dr says to keep on 42u. Now Pebbles is going to have to get a job. I figure $400 this visit next month Cha Ching!!!!The good thing is that she is happy,eating and well worth the expense even if I have to eat cat food for the rest of the year:D:D I asked Dr B if she was available to see Pebbles or do I have to see another Dr as they rotate Dr's in different depts every 2 weeks. She replied that she will be in feline and would love to see Pebbles Shoot I thought she was going to say that she couldn't see Pebs. You know she may be that kind of person that has to grow on you!!!! You know I may end up liking her WHo knows! I think I should give her a chance at least this next visit:confused:

[We Hope]

Marianne,

There's a human internist I refer to scornfully as "God with office hours." :D In his case, it's because I saw him drop the ball more than once; he was removed as a consultant for my mother when I saw him do it the first time. It sounds like this is not the case with Dr. B; you are getting positive results with Pebbles.

Unless I'm not finding it, I don't see the results for Pebbles' Sunday curve; I'd believe that you're happy with the results and that the getting back to the side injections has been good for her bg's.

For more reasons than it lets you give her insulin shot in the side, let's be thankful for Pebbles' healthy appetite. Not long ago, you had "Meatball Mania" in the kitchen when she was being picky! :)

Sometimes, our first impressions of someone aren't on target, especially if we don't feel "warm and fuzzy" about that person initially. When we have more contact with him/her and get to know him/her better, we often discover there's more to that person than we saw at first meeting. The bottom line here is that things are working out well for Pebbles.

Kathy

[rhodesian46]

Oh Dear God,
I hope not again with pancreatitis!!!HAve called Dr B a tA & M as I want to know what to do: whether I should give her smaller meals for the rest of the day(her normal 2 1/2 c at dinnertime split in 4?) MAybe a fluke!!! I gave her an anti nausea pill Hopefully this will go away. I am thinking OMG I can't afford another $1200 bill as I only have $200 saved and just payed off A & M No charge cards either. I am thinking the worse I know but you have the fear that I will have to put my dog down as I don't have the money for care She just threw up again She had been crying trying to tell me that something was wrong She reate it as she did the 2 other times I am freakin big time and I have a really sick stomach right now and am honestly crying Where am I going to get the funds if in fact she needs to go back to A& M today? I am sorry for venting but I am a nervous wreck! I knowthat she didn't get into anything I watch her like a hawk So ya'll say a prayer and hope that Pebbles isn't getting sick again as this happened to me 1 month ago!
MArianne and Pebbles: :(

[rhodesian46]

She threwup again and ate it and is howling trying to tell me something!!! I am hoping an upset stomach! Please let that be that!!!

[We Hope]

Marianne,

Until you can get in touch with Dr. B., I'd say not to give Pebbles any food. When there's a stomach upset and it doesn't mean pancreatitis, you often get told to keep food away for a number of hours to let the stomach settle.

A couple of years ago, I had this situation with Toodles. He also had diarrhea but didn't have pancreatitis. Was told he could have nothing for 4 hours after he got an anti-nausea shot and a bit of sub-Q fluids to prevent dehydration.

Watch her for signs of dehydration--I know you know how to do that. Don't panic--if Pebbles needs some medical attention for this, you may need to take her somewhere locally that allows you to put it on the credit card. You can have them consult with Dr. B. and insist they follow her orders. You DO NOT have to let her go--there are plenty of other options!

Hang in there and keep us posted!

Kathy

[k9diabetes]

Will they take Care Credit? http://www.carecredit.com/vetmed/whycc.html

[rhodesian46]

Ok I am taking a breather Pebbles has not thrown up since 8 am Has re eaten every time she vomits Dr Bostrom called me back immediately. Said to stop giving her her dry OM kibble for a few days She wants me to feed her about every four hours some chicken breast and rice(maybe 1/2 c )I am wondering whether brown rice would be better I asked her and she said no one has ever asked her that question So She ended up eating her full 2 1./2 c OM and little chicken at 5:45 am then vomited 4 x and ate it again I fed her a little water from the chicken being boiled and put a bit of rice and chicken Kinda soupy She ate that At 12:15 Pm today( Dr B wants me to do a bg check every 4 hours) it was 205 I am planning on feeding her around 3 pm then at 9 pm before I go to bed. I believe she wants me to 1/2 the insulin at tonites injection She called in an anti nauseous script called Cerenia( 1 x a day) at a vet down the street. Wants me to also give her human drug called metoclopram as well 3x a day She ended up talking to him via telephone I was able to pay for the drug(4 pills at $42) with my care creadi as I only have a $500 limit. I also brought Pebbles tests from A & M and all of their notes from 12/07 Dr Smith ( he graduated from A & M)there will call me and we will do a phone consult He needs to read the file first I guess it is important to have a vet in Austin just in case. I still would drive to A & M for an emergency and hospitalization as they are more capable to handle over nighters. Dr B said that the bland diet may calm it down So we might of caught this early I hope so.She wants me to keep in contact with her(not such a bad person after all:D) via e mail If an emergency arises like lethargy,inappentance,or vomiting non stop then I need to bring her in You know I wouldn't put her down unless she was in bad shape I just was thinking and was scared that there were no options at all I is scarey when you have spent all that money and you feel like you are reliving it again Pebbles has been crying a lot Needs belly rubs Gald I am off today and tomorrow( no pay) Will stay home and watch her She is a fighter She will get better
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(09/03/08 05:01:01)
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Oh Dear God,
I hope not again with pancreatitis!!!HAve called Dr B a tA & M as I want to know what to do: whether I should give her smaller meals for the rest of the day(her normal 2 1/2 c at dinnertime split in 4?) MAybe a fluke!!! I gave her an anti nausea pill Hopefully this will go away. I am thinking OMG I can't afford another $1200 bill as I only have $200 saved and just payed off A & M No charge cards either. I am thinking the worse I know but you have the fear that I will have to put my dog down as I don't have the money for care She just threw up again She had been crying trying to tell me that something was wrong She reate it as she did the 2 other times I am freakin big time and I have a really sick stomach right now and am honestly crying Where am I going to get the funds if in fact she needs to go back to A& M today? I am sorry for venting but I am a nervous wreck! I knowthat she didn't get into anything I watch her like a hawk So ya'll say a prayer and hope that Pebbles isn't getting sick again as this happened to me 1 month ago!

[We Hope]

Marianne,

Sounds good--small, bland meals and that Pebbles is no longer throwing up. I can see why Dr. Smith needs a little time to go over Pebbles' records because he's now helping with her treatment for this.

Toodles also had some pills to take--after he got the shot, he stopped throwing up and having the runs. I took him to a local ER after I spoke with John about the problem; at the time this happened, John would have had a 50 mile drive one way on a Sunday to treat him at the old practice. I didn't want him to do that, so he told me what he wanted re: treatment and the ER doc did just that.

This could be just a gastric upset--not pancreatitis--but I know after what happened so recently, that was the first thing that you thought of. I sure KNOW that you'd not let her go unless there was no other answer! Also know that sometimes with anything serious, you get very scared and worried and that this can hit you so badly, you have a hard time "finding your way out of that corner". This is where friends come in--they can help you see the way to get yourself out of that corner and do what's needed. :)

I think Pebbles has started getting better now, because she's no longer throwing up.

Hang in there and hang TOUGH, hear? :D

Kathy

[rhodesian46]

SO far so good Am going to feed Pebbles at 3 pm a cup of food I wonder if I will have to 1/2 the insulin in the morning Dr B isn't there at 5:30 am to tell me what to do Will e mail her tonight at dinner and ask Also if Pebs should take her trilo tomorrow as well. Am 1.2 ing insulin at 5 pm today, I feel like I have lost it If I drank I would of been drinking at 6 am just to calm me down.Need to watch her Bgs today Should be Ok on 1.2 dose tonight Right?

[We Hope]

Marianne,

For today, you need to be on 1/2 the normal insulin dose for safety's sake. Everyone wants to be sure that she's over the vomiting before going back to "business as usual"; the last thing you both need right now is for too much insulin to send her hypo.

Good idea to e-mail Dr. B. re: tomorrow's insulin as you'll then know what you're to do in the morning about that and the Trilostane.

You haven't lost it, girl--let's just say you've temporarily misplaced it! :D

Kathy

[rhodesian46]

So far so good It is 8 pm here No vomiting Hope this continues Thanks from all that care I appreciate it. I am still worried though Pebbles is real hungry Can't give her too much food Will feed at 9 pm tonight. What a stressful day I am emotionally drained Will post back in the morning!

[We Hope]

Marianne,

It's a good sign that Pebbles is hungry, and yes, you do need to stick to the small, more frequent meals until you get the "green light" to do otherwise.

I believe the one who handled this better than anybody else is the patient herself! :)

You both need a good night's rest and let's hope tomorrow is a clean slate without any more problems!

Kathy

[eyelostit]

I so wish Pebbles is doing better today, I hope you are OK, your poor little soldier. Maybe she'll perk up and you can get some rest.

[rhodesian46]

Pebbles is doing good:D No vomiting since 8 am yesterday Dr B said to give full dose of insulin this morning Her bg at fasting was 432 Trilo was given as well. I don't know how long to keep her on this diet Dr B hasn't e mailed me yet She is real hungry and wants more to eat It is hard to say no Pebs you have to have little meals Will be home all day to watch her Bgs and her Will post later

[ladysmom06]

Hi Marianne,

Sorry:mad: to hear that Pebbles was having some problems but HAPPY:D:D to hear that she is doing better today. Hugs to you and the gang.

Luv,
Lynne and Lady

[We Hope]

Marianne,

The great news is that the vomiting's gone! Now that you're able to go back to full insulin, Pebbles' bg's will get better. I hope Dr. B. will tell you she can go back to eating as usual, since she's obviously hungry. ;)

Kathy

[rhodesian46]

Gave Pebbles full 42 u this morning Fed her again at 9:30 Her BG was 64 on my One Touch Ultra Dr B wants me to start feeding 3 x a day then 2 x I am not ready to do that today She also wants me to introduce her OM kibble as well. SO at 12:30 her BG was 47 I quickly gave her 1 c of OM kibble which she ate fine At 1:00 her BG was 90.It is going up I now that I still have to keep the diet bland and add OM but I am concerned that her Bg's may drop too low. The Om kibble helps raise her I was going to start adding 1/2 c to her meal 3 x a day but I have decided to add 1 cup then work back up to her 2 1/2 c each meal 1/2 c isn't going to cut it I am going to feed her again at 5 pm ( I may give her a snack in the meantime because at 2:30 she is generally at her lowest)and inject If her Bgs are too low I will 1/2 the insulin( say 100 or lower I think that I will do 3 x a day for a couple ofdays then 2 x a day I was also thinking of trying to give her a small slice of OM canned lunchtime so that her stomach isn't empty and test her Bgs from there That is when she is eating full kibble and her normal chicken and water,. What do ya'll think? Then I will check her at 9 pm tonight to see where she is and may feed her another c of kibble so that she will be Ok when I sleep. Dr B said that I am a good nurse! She is not that bad At least she answers my e mails and has answered me 2 x since 5:45 am this morning Glad that she has held down her food!:D

[We Hope]

Marianne,

I think your plan gets thumbs and paws up! By going gradually back to the OM and the 2 meals a day, you lessen the chances of any more GI upsets.

A good doctor (DVM or MD) you're able to get in touch with easily when there's a problem is a treasure. ;)

Kathy

[rhodesian46]

Ok the saga never ends One of my six dogs the Demon dog named Sabastian got a hold of a couple of Bollilos( they are small rolls) I was busy cleaning the bathroom when I came to the kitchen Ms prissy Pebbles was near the bread and Sabastian was munching I am not sure if Pebbles ate any Gosh Darn never a dull moment here. If Pebbles did eat some I will see a rise in Bgs Am so careful not to leave anything close for any of them to get but probably the husband got hungry and failed to think!!! Normal for a man! Pebbles is real hungry and ate her 1 c of kibble,chicken,water and brown rice. I think she is out of the water and will begin to add more kibble Won't be home in the morning to watch her but my husband will Need to show him how to work this meter as he is used to the freestyle not One Touch Ultra It has been a stressful week Thanks god I am off this weekend All of these animals take a large part of the day They are spoiled rotten. I am taking care of Orfeo a 19 year old outside cat for my neighbors who are in Africa He refuses to come in more than a minute Then I adopted another cat whom I named Cleopatra She is a blue eyed Siamese. Haven't let her loose in the house just one room at night to eat. SHe is friendly but the dogs think she is meat and want to chase her Her nails are extremely long so until I can give her a pedicure they will need to stay away. Husband says we are not keeping her I say she is an outside cat why not HMM is that why she was on my bed last night watching TV with me!!! So wah wah I am keeping her so he has of course agreed. His thinking is that we have enough bills with 6 dogs 2 cats and a bird. My thinking is what is one more Anyway my cats have been healthy and my dogs as well It is Pebbles that is costly SO the zoo gets bigger!!! Thanks for all of your concern You know even though I haven't met all of you you are like family but better There is not a bit dysfunction here!!!

[rhodesian46]

Pebbles was 107 this evening (4 1/2 hours after shot) Know she will be lower later so I gave her 1 1/.2 c of kibble and some rice to hold her through tonight Will test again at 12 AM Dr B e mailed me this evening and said that she wants me to give Pebbles 3/4 of a dose(about 30 u) tomorrow morning until she is back on her kibble completely Gosh I don't like worrying about her Bg especially when she is going toolow

[We Hope]

Marianne,

Now you know she didn't eat any of the rolls. ;) Some people use NPH as their night insulin--many make sure to take a before bed snack to make sure they don't drift too low overnight. I think the kibble and rice Pebbles got should cover her until morning on that score, and I think what Dr. B. told you about giving 3/4 of the full dose until Pebbles is back on OM is right on.

You're gonna need the weekend to rest up from this week!

Careful, girlfriend--you're getting so good at this we could start renting you out! :D

Kathy

[rhodesian46]

Well I didn't listen to the vet this morning Pebbles at fasting was 187 so I gave full dosage and fed 1 3/4 cup of her OM kibble( SHe usually gets 2 1/2 c bid) rice and barley and chicken I thought that she wouldn't go low At 7:30 she was 127 ,10 am 109 fed her 1 c of OM. I am a little confused as she has had more OM then normal and she is still going lower instead of rising a little after food. Know that her lowest is at 2 :30 pm so I am home watching her.You know darn well I will listen to 30 u dinnertime as I worry about her going too low even though the meter is about 40-50 pts lower Also would feeding her 3 x a day when this all gets straightened out help with her pancreatitis I mean not getting it MAybe a little snack mid day? AM planning on dividing her 5 c of kibble into 3 meals tomorrow and see how she does on 30 u as well Also is there such a thing as diabetic dogs going into a coma(like in humans) and would they be hypo or hyper if this happens?

[We Hope]

Marianne,

You could go with a snack about 1-2 hours before Pebbles hits her low at aout 2:30 PM. This gives the food a chance to start being digested and "register" as glucose, so she won't dip so low. What you'd be trying to do here is use the snack to "beat" the low of the peak time of the insulin. Go with the kibble as it has more carbs to it to raise the bg's.

Now all of this might bring her high later, but I'd resist the temptation to go with more than the 30 IU because you might wind up getting into rebound here. Your best friend when it comes to insulin is consistency.

When we had the weak Iletin and didn't know what potency was left in it--had to use it because the new Iletin vial was really weak--we did not change Lucky's unit dosage at all. We weren't confortable "guesstimating" the degree of potency in the old vial and raising his dose, as it may have turned out to cause a hypo.

So the only option here was to stay with the dose and stay consistent in giving it. It took 2-3 days to get Lucky's bg's calmed down (and be able to order a new vial from the pharmacy), but we did that with less than 100% potent insulin--by being consistent with what we were forced to use.

Any being with diabetes is capable of going into a diabetic coma--you can go into one from not having enough insulin (DKA-ketoacidosis) or from having too much insulin (hypoglycemia).

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

DKA-Ketoacidosis

"The vicious cycle is now set, and if untreated will lead to coma and death."

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

Hyperglycemia

About the pancreatitis, Dr. B. seems to think Pebbles will do fine going back to 2 meals a day. I know this is where she wanted you to head for after Pebbles came home from A & M and once again, after this most recent GI upset.

It looks like the problem here is the additional 12 units of insulin this morning, and you're gonna need to do some extra feeding because of that.

Kathy

[rhodesian46]

So until I go 2 times a day and Pebbles is eating full kibble then I should only give 30 units then go to 42 u when she is back to eating her usual 2 x a day? How could she go into rebound if she isn't dropping more than 100 per hour Are you saying at nighttime that I wouldn't know if it did drop?

[We Hope]

Pebbles was 107 this evening (4 1/2 hours after shot) Know she will be lower later so I gave her 1 1/.2 c of kibble and some rice to hold her through tonight Will test again at 12 AM Dr B e mailed me this evening and said that she wants me to give Pebbles 3/4 of a dose(about 30 u) tomorrow morning until she is back on her kibble completely Gosh I don't like worrying about her Bg especially when she is going toolow

Marianne,

When you have to give the snack kibble to raise her bg's they will go higher from the additional food. This is when I would resist the temptation to use more than the 30 IU Dr. B. spoke of, because you've set some changes in motion here by the morning dose of 42 IU and the need for more DCO. When you make too many quick changes, you can (not will), trigger rebound.

You made quite a big "jump" with regard to the insulin--from 30 IU last night to 42 IU this morning.

It looks like there would be no problem with the 30 IU at night tonight--you were giving that yesterday and Pebbles got 1 1/2 cups of DCO and some rice to see her through last night. You had a fasting of 187 after 30 IU and the extra food.

I'd keep watching Pebbles' bg's as you transition back to full DCO and 2 meals a day to see how you think she will handle the full 42 units Dr. B. has anticipated she'll be returning to. If you see a trend toward her having lower bg's, then you'll need to e-mail Dr. B. and outline what you've seen with the 30 IU and the steps back to 100% DCO and 2 meals a day.

Kathy

[rhodesian46]

I went with 42 u last night and 42 units this morning Did I post that I gave her 30? Shoot if I know

[We Hope]

Marianne,

Go back through your posts--yesterday you e-mailed Dr. B. re: Pebble's bg's being low and she told you to go with 30 IU until you were 100% back on DCO.

Well I didn't listen to the vet this morning Pebbles at fasting was 187 so I gave full dosage and fed 1 3/4 cup of her OM kibble( SHe usually gets 2 1/2 c bid) rice and barley and chicken I thought that she wouldn't go low At 7:30 she was 127 ,10 am 109 fed her 1 c of OM.

You know darn well I will listen to 30 u dinnertime as I worry about her going too low even though the meter is about 40-50 pts lower

Dr. B. told you to go with 3/4 of the usual dose, which works out to 30 IU. You went with the full 42 IU this morning.

If you do go with the 30 IU as per Dr. B. this evening, and it comes to the part where you need to increase Pebbles' insulin back to the 42 IU Dr. B. expects she will return to, take it gradually.

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

"Dose adjustments in the dog should be performed in increments of 10%. Following adjustment, wait to reevaluate until the new dose has been given for at least 5 to 7 days, unless evidence of hypoglycemia appears."

If you increase too much and/or too rapidly, this is one way to get into rebound.

Kathy

[rhodesian46]

I went back to my post Dr B e mailed me last night after I has already given her 42 u Will need to e mail her today with more concerns Thanks Lathy:D

[Dollydog]

Hi Marianne,
I've been keeping up with your thread--except for yesterday. But I'm glad to hear things are getting better at your house. You are learning an awful lot about how diabetes and insulin works and you have a very responsive patient! Hope things smooth out for you and Pebbles!
Take care,
Jo-Ann & Lady :)

[We Hope]

Marianne,

It looks like all of us have gotten our wires crossed. :eek: I thought you knew of the 30 IU Dr. B. wanted you to cut down to before Pebbles' dinner last night and that was what you gave after dinner last night. :o

Kathy

[rhodesian46]

So far Pebbles Bgs have been great! Gave 30 u last night
This morning at 5:30- BG 218 gave 30 u Am splitting her OM into 3 meals:1 3/4 c plus chicken and water broth
12:00 pm-113 fed
2:30 pm - 160
4:30 pm -220 fed gave 30
Dr B sent me an e mail last night She says
"I would stay at the 30 for several days into full normal kibble. It is
always better to run a little high. You have been letting her get a
little low. Give her about 3 days on full kibble on 30U. If she is
running high (>300) when she is on full kibble then go back to 42U.
Keep me updated."
Sincerely,
Brier Bostrom, DVM
Tell me what you think If Pebbles Bg's are good on 3 meals a day then I may want to keep her at this Today may be a fluke I don't know She is thinking on 2 meals a day and fastings of > 300 then increase. If her Bgs stay this way I would be amazed at 30 u bid? She was on 24 u when she had pancreatitis a month ago and ran high at 3 meals a day. I want to keep Pebs at 3 meals a day for at least till Wed and see If it looks good then I will throw this idea at Dr B and see what she thinks. Most people can't be home and feed One of us is home at noon so this will work Another question does pancreatitis in diabetic dogs cause higher bgs than normal before it becomes bad? Pebbles is seeing Dr B on Oct 7 for her stim and bloodwork including T4 Will have more questions to ask for sure. So cross your fingers and hope 30 u works!!!

[We Hope]

Marianne,

These are GREAT!! If this continues on 3 meals a day, there should be no reason not to stay with that. For some dogs, splitting the meals into 3 or 4 is the way to make the insulin work best for them--others do great with only the 2 meals.

Some people have noticed their dog starts to go too low around the time their insulin is "peaking" or working hardest. These people give either a snack or small meal before that to counteract the "big drop" of the insulin. In this way, they keep the bg's on a more even keel.

Lucky was the opposite; when we had to go to 3 meals temporarily when he had a little colitis bout, it wasn't as good for his bg's as the 2 meal pattern. Going back to 2 meals for him got everything working right again.

This is such an individualized disease, whether we see it in pets or people, so everyone who deals with it has to find out what works best for themselves or their loved one with diabetes. Just as you might have a problem if you used the same insulin as your neighbor with diabetes, it holds true for meals and foods. Some people with diabetes say they can't even look at pasta or rice without their bg's starting to climb, while others can eat them in moderation without big problems.

You have everything you basically need to do 3 meals a day--someone's home to feed Pebbles her lunch and she's not on one of the one shot a day regimens where if you DIDN'T feed a lunch, there surely would be a severe hypo.

We had someone on another board who was at the one shot a day routine for 7 months. Her dog never regulated and though she would rush home on her lunch hour to feed him, he wound up in the hospital many times with serious hypos. Going to 2 meals and 2 shots a day got him regulated and he had no more hypos.

There's some good evidence that says that subclinical (no signs which would allow you to determine it's there) pancreatitis is common with diabetic dogs--

http://www.uq.edu.au/ccah/index.html?page=43505&pid=0

Centre for Companion Animal Health--University of Queensland (Australia)-2004

LM Fleeman1, JS Rand1, JM Steiner2, and DA Williams2
1 Centre for Companion Animal Health, School of Veterinary Science, The University of Queensland, Australia; 2 GI Laboratory, Texas A&M University, College Station, TX

Chronic, Subclinical, Exocrine Pancreatic Disease is Common In Diabetic Dogs

"We conclude that:

"1) Subclinical exocrine pancreatic disease is common in diabetic dogs.

"2) At least 4 of 12 (33%) diabetic dogs had laboratory evidence of either chronic pancreatitis or exocrine pancreatic insufficiency during a 6 month period."

http://petdiabetes.wikia.com/wiki/Pancreatitis#Treatment

"It may be very tricky to treat, also. It can cause insulin resistance, dehydration, and also nausea and vomiting, all of which complicate diabetes."

So when we talk about insulin resistance, no matter what's causing it, we're talking about bg's that don't seem to want to come down in response to the right amount of insulin being given. High bg's are often the first sign someone sees for an infection also.

I'd say that it's likely Pebbles' running high may well have been the first sign of the pancreatitis attack, but the chances are that if you'd had her tested at that time, you may not have seen anything amiss on the snap test.

If this works, and I sure hope it does, I can't imagine Dr. B. not being in favor of it! :);):D

Kathy

[rhodesian46]

4 1/2 hours tonight after shot 9 pm she was 333 Why she gets more of a rise at night is beyond me!She ate the same amount food and had the same amount of insulin!( 30 u) Will see how her numbers are tomorrow

[Cara's Mom]

Marianne and Pebbles,
Have been following this thread and I do admire you! I can not give any advice, but I am sending my moral support!

[rhodesian46]

THANKS Marion
Pebbles is sure a handful!!! I feel like a nurse!!!:D:D

[rhodesian46]

Kathy,
Dr B said that a mid day snack is fine with her as long as it is proportionally less than her 2 main meals Have been dividing her OM i(5 c) into 1/3's Her low point after injection at 5:30 am is around 2:30 How much do you think I should give her? Maybe a 1/2 c ? She said she looks like she is starting to creep back up and to get with her mid week as we may have to go back up on her insulin So I think that she is thinking going up to 42 u again. I am hoping that she can stay on 30 u and feel good.

[We Hope]

Marianne,

You might see how Pebbles' bg's go with a half-cup of the OM at lunch. From there you can watch and see how she handles that extra food and no insulin. Since Dr. B. says that it has to be proportionately less than breakfast and dinner (And I agree with her, as these are the times you give insulin, thus the main portions of food should be eaten before them.), I think a half cup is a good start.

It should be just enough to keep her from going too low but not enough to affect the timing of the insulin (higher bg's from the snack/small meal). Since you know when Pebbles "peaks" with her morning insulin (about 2:30 PM), then I'd try getting the half cup of kibble to her around 12:30-1 PM so that it's been eaten and has started being digested before "peak" time.

I also think it looks like she's creeping back up from what you posted of last night's test. Kibble is generally higher in carbohydrates than home-made or canned food because it literally takes carb containing items to make the kibble. Dr. B. thought she might go up after going back onto 100% kibble.

But the fact that Pebbles seems to be creeping up with her bg's again doesn't automatically mean that you go from 30 IU to 42 IU--because it may take more than 30 IU but less than 42 IU for Pebbles now. You may find "happiness" somewhere in between the two. :D

So I don't think Dr. B. will tell you to go straight from the 30 IU to the 42 IU, but that if need be, she will suggest you gradually increase, see how Pebbles' bg's are for a time, and then "step up" more gradually if necessary.

If Pebbles needs an insulin increase, it doesn't mean that anyone's a failure here--all of you are winners, because Pebbles is doing GREAT! (No butt-kicking allowed--especially the DIY kind!) :)

Kathy

[rhodesian46]

I measured out Pebbles food for tomorrow 1/4 c lunch is way too little Will go 1/2 like you said Kathy. Gosh Darn Marianne make up your mind girl!!! 12:30 pm will work for me to feed her SHe will then eat 4 hours 15 mns later

[We Hope]

Marianne,

There can be no harm from starting small with the quarter cup to see how it affects Pebbles' bg's. You're being very modest in the amount you want to give as a snack and it sure fits being not in proportion to breakfast and dinner.

Hang in there, girlfriend--we've both been in rougher "fights" than this! ;)

Kathy

[rhodesian46]

I just want this to work To put something in her belly I would rather work up in snack then work down Dr B wants some Bgs Wed. I really think she is going to go 42 like she did when Pebs was hospitalized last month She went 1/2 insulin at first then full 42 u. Would could I suggest to her or question her if she make a 12u increase?:confused:

[We Hope]

Marianne,

Agree with you re: working your way up with the snack.

You have the right to ask if a 12 IU twice a day increase may start problems, since it's 25% more than Pebbles is currently getting and then she is supposed to explain her position on that to you. You might also bring up when you went with the 42 IU and had not yet heard from her re: cutting down to 30 IU that she mentioned Pebbles was going too low at times.

Sometimes you need to be a little like a diplomat to get answers, since you don't know her well. If you put it in a way like that, you're asking her to explain to you why a 25% insulin increase is going to work out without any hitches. ;)

Kathy

[We Hope]

Marianne,

Just saw your edit about the quarter cup being too little. Some people who find the need for a snack around peak insulin time may give only a Milk Bone type biscuit. It depends on the way that individual dog handles his/her food and insulin.

Judging from Pebbles' healthy appetite, I think she will be like the clergy--grateful for any and all "donations"! :D

Kathy

[rhodesian46]

Would it be bad to increase Pebbles to 36 u Lastnight 9 pm -461
5:30 am today-=481
12:15 PM-278
4:30-414
E mailed Dr as far as increase HAsn't answered yet and she is due for her shot

[rhodesian46]

Kathy,
I increased Pebbles 4 u tonight.! :confused:Hope I did right She was too damn high What happens if Dr B says higher than that I didn't mess things up did I?

[We Hope]

Marianne,

I believe you'll need to tell Dr. B. what you did, because there's just no other way to do it if she says to go further than 34 IU at this time. She then gets to chew you out if she wants to :o, but then she will be able to tell you when you should be going to the higher dosage she's prescribing after what happened.

When I needed to talk with John about an insulin increase or decrease and he wasn't instantly available, I'd leave word that I needed to know by X AM or PM because that would be Lucky's meal and shot time.

Since you work with Dr. B. by e-mail, you might try "flagging" an e-mail when it's something like a deadline for a shot or you have what you believe is a serious problem. I'd advise her that you'll be doing it that way ONLY when the problem is either serious or time-related, and I wouldn't abuse that set-up.

I think you'll be OK as you keep a good eye on Pebbles to make sure she doesn't get too low, but the only way I can see for getting back on the road with Dr. B. is to take a deep breath and just say what you did.

Kathy

[rhodesian46]

Thanks Kathy,
Haven't heard from her yet. I doubt very much if she will go low but I will test her before I go to sleep

[rhodesian46]

We are going to 36 u tomorrow per Dr B's e mail. It is not going to hurt Pebbles to go 2 more tomorrow morning than tonight I did 34 u tonight E mailed her to tell her WIll not hear back from her till sometime tomorrow

[We Hope]

Marianne,

Somebody up there REALLY likes you a LOT!

Now--what about you being able to tell us any winning lottery numbers?

:D:D:D:D

Kathy

[rhodesian46]

I would of won the lottery years ago! Anyway Pebbles is on 36 u this morning Didn't expect to see a change yet She wants to give her a few days and then an update.I have noticed since I started her 1/4 c at 12:30 pm that she isn't going her lowest like she always does at 2 :30 ie this morning at 5:30 am-459 12:15 pm-231 fed 1/4c of om kibble and at 2:30 -396 4:30 pm-536 She is getting a big rise from the carbs in the kibbleMaybe I am doing this all backwards !Maybe I should get her regulated again then add a snack Maybe add a 1/.4 c of frozen green beans or maybe a little more This kibble is raising her big time. Any suggestions Do you agree? God I feel like a newbie!!!

[We Hope]

Marianne,

With the way Pebbles' bg's are running right now, I believe you've hit on something--try going back to the 2 meals a day where they are both "covered" by the morning and evening insulin shots. Then we have the carby food and the insulin going at the same time.

A lot of people give green beans as a treat because they don't have any fat in them and not bunches of carbs either, so they wouldn't be raising Pebble's bg's much, if any.

After you get a handle on Pebbles' bg's again with the insulin, however much it's gonna turn out to be, you can then try working with the bit of kibble at lunch if you want to. But for now, I'd think that if there's gonna be any kibble outside of breakfast and dinner, it's coming because she's going too low.

I think if you get back to the 2 meals before the insulin shots, getting control of Pebbles' bg's would be an easier job.

Kathy

[rhodesian46]

See I am using my noodle. AM NOT a dumb blonde after all. Pebbles skin infection hasn't cleared up Dr B e ,ailed tonight and said that they will do a thorough exam on OCT 7 visit She is not bad after all!!! I told her last night" Did anyone ever tell you you are a good vet?" Never thought I would say that She does get back to me Probably is sick of seeing my e mails( Ha):D

[We Hope]

Girlfriend,

You're a veteran of the "Diabetes Army"--after being "under fire" as often as we have, we get smart enough to know when to keep our heads in the trenches and when to raise them up to look around and "shoot"! :D

Well, she DID tell you you're a good nurse FIRST......:)

Kathy

[eyelostit]

Sorry I've been gone awhile, I've had problems with Niki past 4 wks or so, the BG, makes me so upset. Sometimes I can't even post about it until I get her BG in a good range.

I'm glad Pebbles is getting back on track!!:):)

Take care

[rhodesian46]

What is going on with Niki? How high are the Bgs?

[eyelostit]

Well she was going into the high 300's 350 and a 400 I don't know, she had a low one day and got sorta sick after a little walk, its not like we go for a walk all the time, when i go to the food store there is a park there so i take her for a little walk when we headed back to the car she was panting and holding her head down, I just knew her bg was low, so i gave her some of my vanilla latte and a piece of my hamburger bun then a few pieces of kibble I keep in the car, when we got home an hour later her bg was 156 that was 3 hrs after shot, she is never that low after food, so after that she was going low, then the highs started ah it was some hell I did a post under her story about it.

I hope we are back so somewhat normal, you never know about their little bodies, our poor little soldiers.

[rhodesian46]

The stress these little boogers put us under is unbelievable!!! Hope Niki is feeling better today

[rhodesian46]

Well Dr B increased her to 42 u this evening Finally She was high on 36 u. That stupid bacteria skin infection is still there It is aggravating the crap out of me She has had this almost a year now Dr B said that she doesn't want her taking any more antibiotic She will give her a good checkup when she sees her Oct 7th.SO will be watching Pebbles for the next few dys to make sure she doesn't go too low

[ladysmom06]

Hi Marianne,

Just checking to see how Pebbles is doing - hoping:):) she's doing well. Hugs to you and the gang.

Luv,
Lynne and Lady

[rhodesian46]

Will call this weened Lynne Hey Kathy where are you????????????????????????????:D:D

[We Hope]

Marianne,

The high bg's could be at least in part from the skin infection. It may wind up that when Pebbles goes in Oct. 7, she may need to get a skin culture taken, just as Marion's Cara needed the urine culture done to get to the bottom of what antibiotic will wipe out Cara's UTI.

If you're giving an antibiotic that isn't effective for whatever bacteria is there, you're wasting time and money because it won't totally get rid of what's causing it.

Now that Pebbles is back at 42 IU, how do the bg's look so far?

Kathy

[rhodesian46]

I started 42 u last night 4 hours later she was 296 This morning at 5:30 am she was 294 Don'texpect to see a big change for at least 3 days or so. Pebbles had gotten a skin culture from A & M on 4/16/08 The bacteria was a Bacillus species and it was sensitive to clavamox We tried Clavamox 3 times and other antibiotics I am thinking maybe the bacteria has changed or her thyroid may be off She is currently on .5 Soloxine bid. She had a T4 in April as well. No adjustments were made Dr B is going to do blood work and T4 in Oct

[We Hope]

Marianne,

Agree with you all the way around! You'll see what needs work after Pebbles goes in in early October.

Kathy

[Ricksma]

Marianne, I am so sorry to hear the Pebbles is still dealing with the skin problem...you have certainly had your share of problems lately. I will send some good thoughts your way...

Love and hugs, Teresa and Ricky

[rhodesian46]

I feel bad because she has had this almost a year. We get it semi controlled and then it gets worse A & M doesn't have a derm as they are looking for a replacement. So Dr B is handling it. Also Pebbles looks a little freaky Her hair comes in clumps and different colors. Black in some spots. Wish her husky coat would grow in Dr Stone had said that he didn't think it would ever come in So I am praying THey also thought that Pebbles Honers eye syndrome would go away either. Her 3rd eyelid retracted back now. Looks much better, SO Pebbles needs to get her crap together,grow hair,find a job,get rid of her skin infection and blood in her pop That would make me happy!!!

[We Hope]

Marianne,

What makes it hard is that Pebbles has just so darn many things going on that are connected to the endocrine system.

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

The medical terms definition of this is any disease or condition affecting the endocrine system. Diabetes--both diabetes melllitus and diabetes insipidus are endocrine-related conditions. Some other endocrine diseases and conditions which can be found concurrently with diabetes are:

Acromegaly
Addison's disease
Cushing's disease
Diabetes Insipidus
Hyperthyroidism
Hypothyroidism

So many of these can affect the immune system too. Diabetes can affect it and that's what makes those with diabetes more prone to infections. Cushing's does the same re: being infection-prone. So poor Pebbles has two problems that can make for a hard time with getting rid of infections.

The good thing is that you never stop trying because when you do that, she has no chance at all to get her coat back. None of them are perfect, but we love them just as they are--we're not perfect either and they love us anyhow too! :)

Kathy

[rhodesian46]

Need to post a pic of her!!

[Ricksma]

You know, Marianne, now that we are talking about Peb's skin problem, I am remembering a time when my first diabetic baby, Butch, had a terrible skin infection for about a year. My vet at the time was treating him for what he called a fungal infection, and that poor baby was miserable. It looked horrible and was so painful for him. I rubbed ointment on him twice a day for at least 9 months...sometimes it would get slightly better, but not much. We switched vets later on, and the new vet said "Oh, yeah, we can get rid of that." Put him on an antibiotic (sorry, can't recall which one), and within 10 days, it was completely gone. You can't imagine how mad I was!!! Butchie had suffered with that for about a year, and it could have been gone in a matter of days. I know how frustrated you are...you are doing the best possible for Pebbles. Hang in there.

Love and hugs, Teresa and Ricky

[k9diabetes]

Hi Marianne,

It is really difficult with skin issues.

I've posted about Chris' facial ulcerations before... not saying Pebbles needs tacrolimus with the following story - only that it can be very difficult to isolate the underlying cause of the problem. Any kind of skin irritation will invite bacteria so the presence of bacteria doesn't tell you much about the cause.

Chris' dermatologist would have liked to have done a biopsy but that meant anesthesia and a big chunk of skin taken out of his face. Unfortunately, without a biopsy, diagnosis is extremely difficult.

We weren't willing to put Chris through it so tried different therapies sequentially until we found one that worked. In Chris' case, it was tacrolimus, which quiets the immune system/response.

We spent a year trying to sort it out too. With multiple rounds of antibiotics, which did get rid of the bacteria but not the problem. We tried anti-histamines for allergy and steroid ointment for inflammation. No long term success.

An idea...

Since Texas A&M currently doesn't have a dermatologist, ask Dr. B. to consult with

Peter Irhke
University of California Davis

Here's his UCD web page: http://faculty.vetmed.ucdavis.edu/faculty/pjihrke/

I understand that he has an exceptional reputation - I checked it out with all of Chris' doctors and specialists - and he was willing to consult on Chris' case based on a description of his treatment to date and some photographs of the lesions. I had met his wife, Thelma Lee Gross, who is a pathologist at IDEXX here, so had something of an inroad but I know he would work with Dr. B. on this. Both Dr. Ihrke and Thelma Lee are aware of this forum and about Chris.

Dr. Irhke took Chris' case to rounds and discussed it in detail with a handful of doctors and then relayed some recommendations.

As it happened, we were already at the point of trying tacrolimus when we finally got connected with Dr. Irhke. Wish we had contacted him sooner.

Natalie

[rhodesian46]

THanks Natalie, Is there as charge to consult with him? I will pass the info to Dr B I do think though we should rule out an adjustment to her Soloxine first I was also thinking about her letting the head IMS take a peek at her skin when I go to A & M Oct 7th. 2 heads are better than one for sure.Could I e mail him and see if he wants to consult with Dr B? Is tacrolimus a script.? What exactly is it? Glad you are back Hope you had a relaxed vacation You definitely needs it! We missed you!!!:D:D:D:D

[k9diabetes]

Hi Marianne,

Although I don't know for sure, I would guess that consulting with Dr. B. would essentially be part of his job and that there would not be a charge for it.

You can email him though I found that email is not necessarily the fastest way to get to him as he receives a LOT of email. I think ideally Dr. B. or the head IMS at Texas A&M would call him and tell him they have a case that would benefit from his input.

I actually went through Thelma Lee as I was working with her on something totally unrelated anyway.

I gave her a timeline of when Chris' condition started and what we had tried / tested for and then they asked me, in Chris' case, to send pictures of the ulcerations to see if they could sort it out without having to take Chris in. Dr. Ihrke is the kind of expert who, apparently, can often just look at a picture and differentiate the diagnosis. So it would certainly be worth having Dr. B. or the head IMS talk to him about Pebbles.

Because I suspect the bacteria are only secondary invaders of already irritated and inflamed skin.

Tacrolimus is probably a prescription - we got ours from the veterinary ophthalmologist and he dispenses it himself into a tube - gave us 0.02%.

In Chris' case it was an ointment and we used the ophthalmic version of it so it would not be a problem if it got into his eyes since we were applying it on his eyelids.

Just depends on what they think might be underlying the skin problem. Some possibilities are:

fungus
allergic reaction
inflammation
(not sure but endocrine skin problems
may be essentially inflammation
immune system attack
drug reactionSo you could need an anti-fungal, an anti-histamine, a steroid (for allergic and/or inflammation), or an immune-system quieting agent like Tacrolimus, or it could be from one of the other meds.

Here's what Dr. Ihrke said about Chris' ulcerations:

Biopsy not necessary as it was unlikely to yield much useful information and would be hard on Chris.

Differential diagnoses: mucocutaneous pyoderma that was partly infectious (cleared by the antibiotic as Chris' eyelids are much improved after 30 days on Simplicef) and partly auto-inflammatory OR a drug reaction.

In view of his medical problems, none of his medications realistically could be discontinued even if it is a drug reaction and the ulcerations are manageable.

Manage as currently doing, applying tacrolimus ophthalmic ointment and use the low concentration of tacrolimus. Given my concern that the ointment itself bothers him, use it sparingly and less often but for a longer period of time, perhaps several weeks once a day every other day to see if new outbreaks can be prevented. Use antibiotics as needed.

Consider Baytril if an antibiotic is again needed.

[rhodesian46]

Since Pebbles vomiting incident 2 weeks ago we have slowing gone up to her usual dosage of 42 u bid On 9/11 Dr B increased from 36 u to 42 u as she was running high. Wanted ya'll to see this as she is getting lower each day. Her antibiotic for her skin infection ran out 9/10 Still has a bit of the bacterial skin infection. On thurs 9/11 we increased her to 42 u We use the One Touch Ultra I do a 15 mn walk at 6:30 am every day
9/12
5:30 am 294 fed have meds 42 u
4:30 pm 261
9:00 pm 221
9/13
5:30 am 139 fed gave meds 42 u
2:30 p 194
4:30 pm 127 fed gave meds 42 u
9/14
5:30 am- 107 fed gave meds 42 u
2:30 pm 81
4:30 pm 107 fed gave meds 42 u
9/15
5:30 am 89 fed gave meds 42u
4:30 pm 148 fed gave meds 42 u
9/16
5:30 am- 72 fed gave meds 42 u
12:15 pm- 86
2:30 pm- 55
4:30 pm- 58 took out my Alpha trak dog meter and she was 89 This is 11 hours after her shot. I realize that the One touch ultra is lower but I have never seen such low numbers Should I be concerned ? Should I lower her insulin or wait a few more days? Will of course check her at 9 pm to make sure she isn't too low as I go to bed around that time or a little thereafter. Her lowest is usually around 2:30 pm It is weird Her first bout of pancreatitis she was at 49 u bid then was decreased to 42 u She is doing this butt backwards!!!Pebbles never follows the rules. I started a new bottle of insulin and forgot to write down when It could be that. I have already given her her 42 u Will watch her tonight before I go to bed. Am off all day tomorrow and plan on staying home to watch her. Think I will throw this via e mail to Dr B tonight.:confused:

Marianne and Pebbles!

[rhodesian46]

Dr B emailed be back already Wants me to drop to 40 u as of tomorrow and do a curve in a week. I figured thats what she would say

[We Hope]

Marianne,

The new vial might have something to do with it. It's quite rare, but in some cases, a bout with pancreatitis sometimes gets the beta cells working again.

http://www.vetinfo4dogs.com/ddiabt.html#Diabetes%20with%20rebound

"In addition, once in a while a dog with diabetes in conjunction with pancreatitis will suddenly experience a resurgence in insulin producing capability and a sudden "recovery" from diabetes. If you aren't thinking about that possibility it can lead to insulin overdosage. I doubt that will happen after all this time but if the pancreatitis returns and affects insulin dosage in the future, it may be good to keep this in the back of your mind."

I'm not thinking that Pebbles' beta cells might be to the point that she won't need insulin, but it is possible that the pancreatitis attack might have made some of her beta cells capable of producing insulin again.

Hang in there and keep us posted!

Kathy

[rhodesian46]

Pebbles Bg 4 1/2 hours after eve shot was 132. I know she will fall low around 2:30 am tomorrow morning. To be on the safe side I gave her a 1/2 c of kibble. usband will check her again at 12 pm as well Tomorrow we will do 40

[We Hope]

Marianne,

Sounds like a good plan for keeping everything under control! :D

Kathy

[rhodesian46]

Quick question Was on the other dm post Someone questioned that Pebbles could have overlap She wanted to know if I stick with a 11 hour schedule of injecting all of the time as this could be causing an overlap. I feed her at 5:30 pminject as she is eating AM I doing her harm(overlap) in doing an 11 hour schedule like this?If I can't make it on time home then I know I have till 5:30 to be on track. Pebbles has been doing this since dx in 8/07

[We Hope]

Marianne, there's generally a one hour window where you can be either up to an hour early or late and it shouldn't be a major problem.

This is the way you've been giving Pebbles her insulin ever since she had diabetes, is that right? If this is how you've been doing it all the way along, then I think you would have seen overlap problems before this.

We have someone here who was once a member of that board and is a present member of this one whose dog was on a 10 hour schedule--only 10 hours between insulin shots. This is what worked best for him.

Kathy

[rhodesian46]

Yes Kathy I have always done this 11 hours apart You know some people freak if it is not exactly 12 hours apart I would think too after all those curves I have sent to A & M since Dec that they would of said something as well I ahve been told as well about the hour window Some make this sooo confusing that if late on shot then they go late on second shot and then work them selves back to the normal schedule That is too confusing for me Went to 40 u today Need an opinion please As you already know I fed Pebbles again at 9 pm last night (1/2 c of kibble) Of course she was almost 300 at fasting this morning 6 hours later 194 then at 2:30 am-53 got my alphatrak out real fast It registered 89 Then at 4:30 fasting she was 69 . She is actually higher than that as I use the one touch ultra But still I would think a decrease would make her bgs go higher What the heck is going on?. Does it take a few days to work like if I were to increase insulin level? To be honest Pebbles never got a decrease so I don't know!!! I never thought I would have to worry about this SHe is freaking me for sure I hope she levels out. PLease reply back

[We Hope]

OK, Marianne,

Since you've been at the 11 hours all the way along and you never saw Pebbles do anything like this before, again I believe you would have seen an overlap problem long before now.

We can explain this morning's 300 fasting because she got some kibble after her evening shot, and since you've been having problems with her going low, you were right to give that at 9 PM.

So 6 hours after breakfast and insulin, Pebbles was at 194, then at 2:30 PM, which you know is when she will run lowest from the morning insulin, she was down to about 53.

No, decreasing insulin shouldn't take 2-3 days to show up, because if if did, when you have a case of hypo or low, you'd need to keep going and going with the sugar and extra food for 2-3 days if that was so.

What about giving Pebbles a half cup of OM at about noon? This should stop that slide into the 53 range as it will start to be digested and get on its way to becoming glucose before we get to Pebbles' peak at 2:30 PM from her morning insulin.

I do think that since this looks like it's becoming a regular situation with Pebbles going that low at about peak time of her morning insulin, you need to e-mail this to Dr. B. We can keep her out of trouble with a 1/2 cup of OM at noon, but I think Dr. B. may want to possibly do some more insulin and/or food adjusting because of this.

Hang in there--we'll head 'em off at the pass, girlfriend! :D

Kathy

PS--if you had overlap going, I don't think Pebbles would be at 300 fasting this morning.

[Ricksma]

Marianne...when I know that I am not going to be here for some reason to give Ricky his shot, I adjust by hour intervals...if necessary. You have that one hour leeway, I have never felt it necessary to adjust for several days by a few minutes each day. As long as you stay within the one hour, you should be okay. I think Kathy has a good idea with the extra food...your doctor will tell you for sure. Wow, Pebs, give mom a break!!

Love and hugs, Teresa and Ricky

[We Hope]

FWIW, Lucky was on a 12 hour schedule with food and insulin. When we got to the time changes--either going ahead or back an hour, I kept one of the clocks set to the old time for the first day after the time change. I'd give him his food and insulin 12 hours apart that way.

After we made the changes and I was giving all insulin on "new time", I'd set that particular clock the same as the rest. He didn't get it too early or too late like that.

Just my way of dealing with the time changes. :)

Kathy

[rhodesian46]

Thanks Teresa and Kathy,
I am not as concerned on the bgs during the day as I am at night while I sleep I am lucky to have a night owl of a husband He will check her midnight for me if need be .I check her at 9 pm. I will see what her fasting is tomorrow morning Dr B wouldn't answer my e mail this late any way Will e mail tomorrow if this continues I can't see waiting a week to do a curve if she is going low like this.

[We Hope]

Marianne,

While Dr. B won't be answering your e-mail this late, you can reach her tomorrow. In the meantime, your best weapon is the extra OM at about 9 PM tonight and then around noon tomorrow.

I remember Dr. B's expressing some concern at one point that she was getting too low--you can keep that from happening with the extra kibble.

Hang in there--Pebbles must be loving the extra food!

Kathy

[k9diabetes]

Marianne,

Just want you to know I'm thinking of you and Pebbles. I will get back later today and catch up on her thread... got to go do some paying work first... I know these lows are worrisome. I hope it's overall a good sign that some of her issues are settling down and so less driving up the blood sugar.

Natalie

[rhodesian46]

Dr B answered my email as I was getting concerned with her lows She says"
"Let's try 38U and yes increase her intake. It could be due to a
combination of things, decreased insulin resistance due to control of
Cushings, hypothyroidism, or skin infection vs changes in diet etc. Is
this a new bottle of insulin?"
I opened this bottle around a week ago Didn't record the day though Know that it was a different expiration date So I will try 38 u tonight and see how she does.Pebbles is making me grey!!!

[We Hope]

Marianne,

When we'd start a new insulin vial, we would notice that at first, Lucky might be slightly lower than usual; but it wasn't low enough for a need to reduce his dosage. I always wrote the date I started the vial on the front of the box to "remind" me twice a day how long we'd been using it.

As long as you started this vial a week ago, I think this isn't it. What Dr. B. has mentioned is any number of things which could be causing Pebbles to need less insulin; you might not know which one or ones it is until she goes in for that early October checkup.

You keep a very good eye on her so you'll notice if she starts sliding low again and then you'll need to get the OM out.

One thing both you and Dr. B. can say--Pebbles sure isn't dull and boring! :D

Hang in there--you'll all make it!

Kathy

[rhodesian46]

How much plain yogurt to give Pebbles at 55 lbs?

[Cara's Mom]

Hi Marianne!
If it's any help, Cara gets 2 tbsp fat free plain yogurt right on top of her meal. It's the first thing she licks up!
I am sorry for all the troubles you have right now. You both are in my toughts!!

[rhodesian46]

Thanks Marion. Is Cara around 55 lbs? ANd did her Bg's go up a little because there is sugar in the plain yogurt.

[Cara's Mom]

Cara is 48 lbs right now..Her Bg's have been high all along, so it's hard to say if yogurt is the culpert. But she's been eating yogurt for a long time!

[k9diabetes]

So Marianne!!

So I waded through all the posts since September 4... What a rollercoaster you have been on!!! I wouldn't be surprised if you've pulled all your hair out. :eek:

It is really difficult when you have to make diet changes and worry about the insulin dose at the same time! :(

Have you been able to stabilize Pebble's diet in the last few days?

What is she currently eating and how often?

I would have preferred, as Kathy mentioned a week or so back, to have nudged her insulin dose up gently from the 30 units until you found the right dose for her rather than making the big jumps that Dr. B made. You follow her closely and can compensate the lows but I think it would have saved you some stress plus made it easier to evaluate what dose works for her.

I think it's basically always better to work up slowly to the right dose than to jump way up and then have to try to work backward. When you get into having to feed lows, it blows the consistency of the food regimen and that makes it difficult to know what the food and insulin are doing.

My guess is that there's some adjusting going on with Pebbles in response to the bland diet, which could relieve some inflammation in the digestive tract, and relief of infection from the antibiotics.

And then also in relief from the higher blood sugar reducing insulin resistance, which may be partly why you saw her blood sugar steadily dropping on 42 units from the 12th to the 15th.

At first 42 units wasn't too much as she may have had some insulin resistance built up. But as that cleared, 42 units was steadily becoming an overdose.

Going to 38 units sounds good. You may find she stabilizes there or you may find that something like 36 units, which didn't work before, works now on her current diet and after some low to normal blood sugars reducing the resistance to the effects of the insulin.

In treating lows, I usually gave syrup because I knew it would get in quick and also not send Chris' BG high later in the day. Especially in his case... he tended to digest carbs slowy. Simple syrup was far more predictable with fewer consequences in later hours.

If you're treating a low at 9 hours after injection, sugar might be the better choice as it will raise the glucose just for an hour or two and then you can reduce the insulin dose in response to the low and give the normal meal.

Sounds like you're getting there. Rocking the boat as much as you have had to do always winds up stirring the water for days and weeks afterward. Once you can get back into a routine, things will settle down. Try not to worry about a little higher blood sugar - opt for that over upsetting the routine so you can continue to adjust and make changes slowly.

Fun... :)

Natalie

[rhodesian46]

This is hard for me to understand The food change was done 7/27 to OM kibble Why didn't her Bgs straighten out then or a little thereafter We went from 49 u to 42 units after the first bout of pancreatitis then went lower after that I lowered her from 40 u to 38 u 9/18 at her evening meal 9/19 at 5:30 am shewas 236 fasting,4:30 pm 82 and at 9 pm- 139 I fed her 1/4 c of kibble as I was concerned that she would go too low by 2:30 am This did raise her this morning to 435!! 11:30 am- 181 and 2:30 am 109. She eats 2 1/2c of OM with water chicken broth with some white chicken each meal If I were to give her some Karo syrup at night that wouldn't help her after a couple of hours right? What about giving her a tad more in her evening meal instead? I should be ecstatic with her numbers I know I am not used to this(dropping insulin amount after over a year with Diabetes and 9 months with Cushings. ANy suggestions or should I just see what her numbers are tonight?

[We Hope]

OK Marianne,

We can try these possibilities:

1) Pebbles had some inflammation left from the pancreatitis bout that she went to A & M for. Now it's cleared up and so she needs less insulin. For all we know, she may have had some subclinical (there but not able to be detected in testing) inflammation of her pancreas for a while. The first "notice" gotten of it was when she became so sick and had to go in to A & M; by that time, it was able to be spotted in tests.

2) Pebbles' Cushing's is under better control and this means less insulin resistance, so again a case for less insulin needed.

3) Pebbles' hypothyroid might need work. Hypo-T means sensitivity to insulin until it's brought into proper control. If the Hypo-T is an issue, that would call for less insulin.

4) Rare, but not impossible. Pebbles' pancreatitis bout "re-activated" some of the insulin-producing beta cells of her pancreas. If she's able to produce some insulin on her own, she will need less by injection.

Right now, we can only look at the possibilities--until Pebbles goes into A & M early next month and gets a good check-up.

You're right about the Karo. Sugar and syrups are "quick fixes" only. They will quickly bring bg's up, but they don't last. They are simple carbs, meaning they are easily digested and work fast--they're also easily passed from the system. They are Part #1 of getting out of hypo/low.

Part #2 of getting out of hypo/low involves eating something with complex carbs in it; they are not so easily digested as the simple ones, so they don't start working right away. They last longer in the system too. Kibble would be a complex carb. They tell people to eat something with complex carbs in it (sandwich--bread is one) about 30 minutes after they take something with sugar in it for a low. This makes sure their bg's don't rocket down again once the sugar's out of the system.

Why not try extra in the evening meal and check her as you do at 9PM? Then, if it looks like she needs it, you can add a little more kibble for overnight. This makes sure Pebbles does not go too low overnight.

I sure can understand; her numbers are great, but there's such an uncertainty here as to whether she's going to go too low. Half of you is thrilled, while the other half is worried about lows and hypos.

Hang in there, girlfriend--October and (we hope!) answers aren't that far off!

Kathy

[rhodesian46]

I think you are right about adding a little extra to her evening meal. At 9 pm tonight she is 126 on One touch ultra She will go lower by 2:30 am I know .I gave her a 1/4 c of kibble Will see how her bg's are in the morning. I know thatwe are at the tweeking stage now. Whether I feed her a bit more for dinner or at 9 pm we will see. Need to do a 24 hour curve soon when I get this pretty ironed out. Haven't done one of those in a year.Thanks guys for your explanation or possible one At least it is not bad news. I can deal with this easy!!!

[We Hope]

Marianne,

Just remember, if you feel that Pebbles is still going too low with the additional food, you might need to e-mail Dr. B. again about a possible further insulin dosage reduction.

I think this trip to A & M for her check-up, Pebbles ought to be charging them for the privilege of seeing her! :)

Hang in there--we'll all make it through this!

Kathy

[rhodesian46]

Cant feed Pebbles at ( pm For the past 2 days that I have donethis she gets af fasting in the morning in the 400"s.(fed her 1/4 c of OM kibble) So tonight i am going to set my alarm for 2:30 am and check her just to see how she does at night Will of course do a 9 pm check as well She might be staying the same as all of her curves were always flat.Gosh this is alotof work!!! But Pebbles is definitely:) worth it

[Ricksma]

Wow, Marianne, no one can ever say that you are not a dedicated furmom, that's for sure. Hopefully you will get some useful information out of this...

Love and hugs, Teresa and Ricky

[Cara's Mom]

Goodmorning! (do hope it's a Goodmorning for you!)
Just checking how you and Pepples are doing!

Best wishes!!!!

[We Hope]

Marianne,

I agree with you re: what happens to Pebbles' fasting bg's when the OM has to be given at 9PM. It throws off the insulin action and this is why you see such high fasting bg's. But in an emergency, such as if you thought she might go too low overnight, better to need to deal with higher fasting bg's temporarily than a hypo.

Think that if the extra went into the evening meal, it would do what we want it to--keep her from going too low overnight--without messing up the insulin action and creating those high fasting bg's.

You're darn right, she's worth it! We all have shares in Pebbles, Inc.! :D

Kathy

[CarolW]

Cant feed Pebbles at ( pm For the past 2 days that I have donethis she gets af fasting in the morning in the 400"s.(fed her 1/4 c of OM kibble) So tonight i am going to set my alarm for 2:30 am and check her just to see how she does at night Will of course do a 9 pm check as well She might be staying the same as all of her curves were always flat.Gosh this is alotof work!!! But Pebbles is definitely:) worth it

Marianne - I read your entire thread; took me two days! Really worth reading. You are amazing. And wonderful. Lucky Pebbles! Yes; what a LOT of work! And I agree, our dogs are worth it. All the same, I go on bended knee admiring your care of Pebbles. Indeed, you are an amazing nurse! Surely Pebbles can only benefit!

Hugs to you and Pebbles, from our animal family.

Mon, 22 Sep 2008 18:08:32

[eyelostit]

Hi Marianne, I'm just a wondering, with reading all of the posts, I am wondering why Pebbles gets a large dose of insulin, is it because of all that has happened with her?

I know some dogs do get a larger dose of insulin at 50 lbs depending on their bodies, but darn I never had luck with Niki when the vet up'ed her to 18-14 units after a 3 month period.

Oh anyway i am just thinking out loud, I looked back at some posts but could not see what insulin you are using.

Have you tried Sulfodene for her skin?

Maybe I am just nuts this evening, so ignore me if I don't understand the insulin amounts.

We had a time today, a thermometer got broke and I was hunting the mercury that no doubt spilled out on the floor and I think it went down the heat duct, I was worried Niki may eat it, so we never found the mercury beads or the other end of the thermometer. its always something.:confused:

I hope things get better, I feel bad for what you and Pebbles have gone thru, rough road, but you sure are taking care of your baby.

Take care

[rhodesian46]

http://caninecushings.net/forums/showthread.php?t=5881
Carol, Sent you another link This is where I first posted Pebbles and her cushings and misdiagnosis of her butt face vet Pretty long but worth the reading. I too was new at this last year.

[rhodesian46]

Hi Niki,
haven't tried sulfatene for her skin yet Where do you get it? To answer your question Pebbles started out conservatively on her insulin dose as she was dx in 8/07 with diabetes. She would do real well on a dose then would have to be increased as that dosage was insufficient There was some insulin resistance due to her having cushings which was dx in 12/07 The insulin amount was supposed to be decreased as the cushings was regulated but that didn't happen She was never the textbook dog and broke all of the rules Recently she has decreased the amount of insulin after way over a year now Also for a cush pup and weight considered she is also on a low dosage of trilostane for her weight Go figure !!! She is complicated I am on her like glue. BTW she is now on 38 u bid and doing pretty goo so far SO when vets say thata dog will be regulated on such an amount of insulin say I know a dog that is different Isn't Pebbles great She is different Need to post a pic of her Went to take a pic today Daughter took memory as she is getting pic from her trip Oh yeah forgot to add that Pebbles horners eye syndrome( 3rd eyelid retracting) is 100% better.. She broke that rule tooo

[rhodesian46]

Hey ya'll,
So far Pebbles is doing well on 38 u bid Here are her I lowered Pebbles insulin from 40 to 38 per your request on 9/18
eve.Here are some of her Bg's
Fri I am still doing 2 1/2c of om kibble bid. No change of diet at all Here are her bgs so far

9/19
5:30 am 236
4:30 pm- 82
9:00pm 139
9/20
5;30 am- 435
2:30am 109
4:30 pm- 93
9/21
5:30 am 421
2:00 pm- 127
9:00 pm 186
9/22
5:30 am 318
2:30 pm- 144
4:30 pm 267
9:00 pm 143
9/23
5:30 am 466
2:30 pm 118
4:30 pm 164
Today at fasting 5:30 am She was 428 It looks like the pattern is that
she is fine during the day but is rising at night I e mailed Dr B She wants me to keep at 38u and is happy with her Bgs As far as night time goes she said better high than low. I wanted to give her an extra unit at night. There is no additional food given. She is still a lazy but. The only thing I can think of is is that Pebbles goes on a 15mn walk in the morning This may be lowering her Bgs a bit As far as nighttime goes she lays around like a lump( Ha) She ihas a grate bg at 9 pm(a little over 4 hours after her nighttime shot) Any feed back would be appreciated!!!!!!:D


Marianne

[We Hope]

Marianne,

I think you found the answer once again! The difference looks like it's in the morning but no evening walk. Pebbles is getting the same amount of food and insulin morning and evening--but she only walks in the morning. ;)

Take a look at what Marion's posted today about the half hour walk and Cara's bg's on Cara's thread and you'll see what kind of effect it can have on the bg's.

One other possibility here--you're on an 11 hours between food and shot schedule. Nothing wrong with that because it's worked great for Pebbles ever since she had diabetes. So during the day she goes 11 hours without insulin; but from evening shot to morning shot, she would be going 13--the "extra" hour and then the 12 hours. And that could also account for the higher fasting bg's.

You might be able to make a dent in those morning bg's if you could walk Pebbles in the evening for the same 15 minutes as you do in the morning; you might be able to get them to come down with the insulin dose Pebbles is getting now.

Just something to think about, girlfriend! :D

Kathy

[k9diabetes]

Kathy made some great points on the high readings in the morning. Could be a combination of small bumps from all of those things.

I wouldn't be surprised if going 13 hours at night has a lot to do with it and most likely the rise is a steep one just during the last hour or so before breakfast, in which case it's really not a big deal as it's a short period of time. Her blood sugar for 90% of the day is in a good range.

When the insulin runs out, it can do so kind of abruptly. Since her am meal stretches just 11 hours, could be the night time dose runs out as early as 11 hours, leaving a couple of hours for the BG to start climbing up.

This is really pretty exciting. It's amazing how much her insulin needs have dropped!

Natalie

[rhodesian46]

Yes I want to jump up for joy!!! Now calm down Marianne. MAy try to walk her in the evening It is just so hot here That is why I walk her early in the morning Would like to set my alarm this weekend just to see how her numbers are around 2:30 am. That is really hard for me as I have to get up at 5:30 every day One night won't hurt me I would of never believed that Pebbles insulin level would of dropped from 40u to 38 u!! I just hope all of her blood work gets aced in Oct!! Then for sure I will get my dancing shoes on. Pebbles is definitely not your text book dog for Cushings or diabetes!!!:D:D NAtalie the weird thing is Pebbles Bgs were usually pretty good This girl is changing her MO too much lately Oh yeah I forgot to add I got a 4 pk of Cerenia for Pebbles just in case she vomits again. It works wonders I would really recommend any of ya'll to have this on hand as Dm and cush pups are prone to getting pancreatitis It is give once a day for 4 days.This is to stop the vomiting. Dr B faxed the script to www.petshed.com.They are reasonable and have generic heartworm meds(no rx required) for my 6 dogs.Theyare in Australia. Have been dealing with them for ages. Check it out! No I am not on commission!!!

[We Hope]

Marianne,

She's doing really well with the 38 units twice a day! I'm thinking that she will get a fine report from Dr. B. when you take her to A & M. You both might look at her as the one we don't quite understand, but I think you both will be happy with Pebbles' results. :)

We'll all be waiting to hear what results you get when you try the evening walk. ;)

Pebbles does have a job--it's keeping you and Dr. B. sharp. Now she's waiting for you both to pay her! :D

Kathy

PS--We forgot another thing that changed not so long ago with Pebbles--you stopped giving her shots in the neck scruff and switched to the sides. I'd think this may have helped her use less insulin too, because the absorption's better than in the scruff.

[rhodesian46]

Hey ya'll,
Have been watching Pebbles very closely as her right ear looks a little red. No foul smell She is not moving her head side to side and very rarely is scratching it Maybe I should take her in?Also on the side of her face just below her right ear is a growth. It is the size of a large tick Round in size and skin colored I guess I shouldn't freak Need to wait 2 weeks before I see Dr B What do you think it is?

[We Hope]

Marianne,

I'm at a loss here. Not sure--maybe someone else has some answers--but you might drop Dr. B. an e-mail describing all of it so she can tell you whether anything needs immediate attention or not and can make a note on Pebbles' records to have a look at all of this whe she does go to A & M.

If Dr. B. says someone needs to see her before 2 weeks are up, you could take Pebbles to the local vet who helped you out with the antinausea meds, as he's read her records.

Sorry!

Kathy

[k9diabetes]

Assuming it's not a tick...

She might have scratched her ear while scratching at the blob, which could be a lipoma, a warty growth, or something more serious. Chris had quite a few little benign warty growths about that size.

If you can, email a picture of it to Dr. B.

Is it smooth or lumpy?

Embedded in the skin or sticking up from it?

Hard or soft?

[rhodesian46]

IT LOOKS LIKE A RAISED RAISIN.LOOKS like it has blood flow to it, Is hard though. God something else for me to worry about!!!

[We Hope]

Marianne,

Does it look anything like the photo at ths link?

http://en.wikipedia.org/wiki/Image:Tick_engorged_with_thumb.jpg

Photo is huge, so am posting link only. The photo is a deer tick on a small child's head.

As Natalie said, if you can get a photo of it to Dr. B., it would help in finding out what it is and what to do now (if anything) about it.

Kathy

[rhodesian46]

No it doesn't look like that I have taken pics of it and sent it to Dr B Don't know how to send it to you only via e mail Will keep u posted!!!!

[k9diabetes]

Dr. B will certainly give you an answer but I'm curious... feel free to email it to me. k9diabetes@gmail.com.

Natalie

[k9diabetes]

Marianne sent me this picture earlier today but this is the first chance I've had to post it. I've never seen anything like this - has a blood supply.

http://www.randomfierce.com/canines/pebblesbump.jpg

[k9diabetes]

Possibly this: http://en.wikipedia.org/wiki/Histiocytoma_(dog)

http://upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Canine_histiocytoma.jpg/180px-Canine_histiocytoma.jpg

[k9diabetes]

Definitely sounds like histiocytoma... http://vetmedicine.about.com/od/diseasesconditionsfaqs/f/FAQ_histiocytom.htm

[rhodesian46]

Hi Natalie,
When I got off the phone with you I googled it I really thought it was this but you know me I was worried. Dr B hasn't gotten back to me She is probably waiting for the curve that I am doing today.I walked Pebs last night She was limping when I got home Walked the same 15 mn, same Street But this time I took her sister Jasmine They were on retractable leashes Jazzie likes to do 360 degree turns as she is walking They were strutting their stuff The they got tangle I tried to get the leash untangled from Pebbles back leg but the dumb butt decided to go the opposite direction and screamed. SO I may try to walk her just down to the corner for now Maybe 5 mns instead of 15 at night They used to walk 5 miles together in the woods and loved it. Don't want to push Pebbles though Will post curve later

[CarolW]

Marianne - Retractable leashes, as you found out, MIGHT be okay if one of the dogs is off-leash entirely; I've walked mine that way, always with one dog entirely off-leash. With two, I use standard leashes only, no retractables.

If you're increasing Pebbles's exercise, I'd go SLOW - 5 miniutes more at a time, not a sudden doubling of her daily exercise! See how it goes! Hope her back leg is okay! (Dogs often don't understand leashes, especially not retractable ones.)

I'll watch for your curve!

Sat, 27 Sep 2008 12:21:06

[k9diabetes]

Clearly you are gonna have to have a long talk with Pebbles about her free-spending lifestyle of growths and leash wrap injuries and other such Marianne-gray-hair-inducing behavior!!

Hope her blob is a histiocytoma as it looks like you can just ignore them and the usually will reabsorb on their own. They are nasty lookin' little things though, aren't they? One of the articles described them as "angry looking growths" and I couldn't agree more with that description.

Sorry I had to hang up the phone the other day Marianne - some stray dog drama has been ongoing all weekend and I was waiting for a call to continue all the fun I was having in that department. Long story that I'll share after it's all settled.

Natalie

[rhodesian46]

Why bother coloring my hair At almost 50 I am practically grey raising 2 girls One 27 and married the other wil be 21 this Tuesday Plus Pebbles. Will walk her soon just down the block. You know they almost tangled my butt with those leashes. So I definitely noticed lower Bgs at fasting this morning due I think to a short walk last night
Her Bgs yesterday kinda concerned me AT her normal low at 2:30 pm she was 87 at 4:45 pm at fasting she rose to 247!! Go figure The walk was at 7 pm
Her curve was pretty damn good today
5:30 am fasting 211
6:30 am 347 then walked 15 mns
8:30 am- 253
10:30 am 242
12:30 pm 143
2:30 pm- 101
4:30 pm 97
She did have a pretty big rise from her food this morning. Weighed her yesterday on the same vet scale as last month She was 55.4 last month 55.2 lbs Dr B wants her to stay this weight and to keep track of her weight monthly. And Natalie I understand that you had to get off the phone. I don't think you were rude. Ok when you call me I will say I have to go!( Ha) Hey where has Kathy been? She is not allowed to take days off! (He He) If I don't post later that means these friggin huskies made me fall andI feel flat on my butt!!! You know I feel bad tht I can't take all 6 I used to take 5 until Demon Sabastion came along! I sneak them out through the garage.

[k9diabetes]

Kathy's been struggling with a bit of unrelated drama herself and I think she just needed to detach herself from the computer for a while! :)

Be safe on your walk!!

Natalie

[Cara's Mom]

Hello Marianne!
Know what you're going thru walking those dogs!!! Use to do it with 5 English setters . One was a pup (Cara) and one was a senior (12 yrs), the rest were adults. Lots of fun!!! Made sure I walked early...nobody in the park to see us:D:D:D
Take care of yourself!

[We Hope]

Marianne,

It looks like all the "misery" was worth it because we sure do see a lower fasting from "the walk".:D

When you get the curve to Dr. B. you should mention that you've started doing a little evening walk in addition to the usual morning one, so she can understand how you beat the fasting bg's that were starting to sneak up.

You have the makings of a dog sled team there--maybe you need to get something so you can just yell "Mush!" and they pull you while getting their exercise. ;)

I think Dr. B. will be VERY pleased with Pebbles when she goes in!

Kathy

[rhodesian46]

Thanks Kathy. We missed you. Any ideas on her growth?

[We Hope]

Marianne,

It looks a lot like the photo Natalie posted. Lucky had some assorted warts in various spots. I kept an eye on them and if they seemed to be getting bigger or looked different, I'd have John take a look at them. They were never anything bad or needed to be removed.

Dr. B. will be getting back to you on Monday re: the photo of the growth and Pebbles' curve, right?

I think now that she's seen a photo of it, she'll be able to tell you what she thinks this is and what, if anything, needs to be done about it.

Kathy

[rhodesian46]

yes she will get back to me probably today But she knows that I am coming to see her Oct 7th Pebbles will get her stim,electrolytes,blood panel including thyroid . So she will see it then.

[rhodesian46]

Dr B said that the growth looks fairly benign Possible papiloma( wart). She will aspirate it in the 7th. She wants me to reduce insulin level to 37u as 36 was too low Maybe a happy medium she thinks. I e mailed her back and told her that the One touch ultra is between 30-50 points lower than the lab or dog meter. I think that she is seeing 97 and saying too controlled What do you think? It is difficult for me to gauge 37 when the syringe goes in 2 increments! http://www.marvistavet.com/html/body_canine_viral_papillomas.html

[We Hope]

Marianne,

That's GOOD news--Dr. B. saying it looks like a benign wart! :)

Now, about Dr. B. and 37 units...I have to side with her regarding 36 probably being too low for a dose. Remember, while we talk in terms of units in a single insulin dose, sometimes it's easy to forget that we do this twice a day. So when we're reducing the insulin from where Pebbles was--38 units twice daily--to 37 units twice daily, we are in reality cutting 2 units a day from her dosage. Going from 38 to 36 units twice a day would mean dropping a total of 4 units in the daily dose--and there's where I think the problems with higher bg's might begin again. Sounds like she's joined our quest for "happiness":

But the fact that Pebbles seems to be creeping up with her bg's again doesn't automatically mean that you go from 30 IU to 42 IU--because it may take more than 30 IU but less than 42 IU for Pebbles now. You may find "happiness" somewhere in between the two. :D

Are you having problems with needing to split each dose because you're trying to use up some 3/10 cc syringes? 1/2 cc ones hold 50 units and 1 cc's hold 100 units. If so, just make one shot 19 units and the second 18 units until you can get hold of some 1/2 or 1 cc syringes with the short needle.

I think going with the 37 units as Dr. B. wants would be fine--this looks to me like it will keep Pebbles in control without sending her possibly too low at that 2:30 AM & PM where she peaks.

Soo--the quest for happiness--are we all gonna take up yoga and chant OM? :D

Kathy

[rhodesian46]

I have 1 cc 31 gauge 5/16 " Can't gauge 37 real well The 1 cc doesn't come in 1 u increments? At least not Wal MArt Relion or does it? Does the 1/2 cc go in single increments? I just didn't understand why Dr B is reducing the dosage at all? I just don't see why? Another question is if I am reducing the dosage then why do a curve in 2 weeks for her? I will see if she is or isn't going to high. I think her thinking maybe that she wants her in the 200 range. I don't know Will ask her when I see her. She is not in detail on her e mail lie Dr Stone was. Will reduce tomorrow and see where she is at.:confused:

[eyelostit]

Hi, you can get the sulfodene at Walmart at the dog items, at least its one that is affordable.

I swear it made one of Chief's (Cushings dog) cultenous? bumps go away.

I always used this for hot spots or years ago before Frontline and flea med's for the flea bites and where they would lose some hair, always worked.

That wart looks like the thing my dogs have gotten over the years, it would appear on top of their heads or elsewhere (Chief had one!) His itched and he scratched it open, I never could see how bad this got after his scratch open until i was combing him and seen a black spot on top of his head I looked at it and here the skin was infected, it looked like his skin had actually split and I was looking at a muscle but that was not the case at the vet it was an infection, they shaved the area etc, I could not believe how thick an Akita's hair and skin is.

Anyway with my dogs the warts do sometimes fall off.

Take care

[rhodesian46]

Tanks I will look for it!!!:D

[We Hope]

Marianne,

See if this table for syringe barrel markings might help:

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

You'll see links to where you can view the various brands. According to when we did the table on the wiki, some of the brands do have single unit markings on their 1/2 cc syringes.

OK--we got W-M/ReliOn to tell us what's up with their syringe markings:

http://www.relion.com/information/faq-insulin_delivery.htm#4

"What kinds of markings are on your syringes?

"Our markings range from ½ unit to 2 unit increments, depending on the volume of the syringe. Here is the breakout:

1cc - 2 unit increments
1/2cc - 1 unit increments
3/10cc - ½ unit increments

http://www.relion.com/information/faq-insulin_delivery.htm#2

"What does the gauge number (and other size numbers) mean?

"The higher the gauge number, the thinner the needle. Gauge numbers for insulin syringes are 27 to 31. We have 29, 30 and 31 gauge in our line.

"The length of the 29 gauge needle is ½ inch.

"The 30 gauge and 31 gauge needles are shorter, measuring 5/16 inch.

"Use 3/10cc syringes for up to 30 units of insulin, 1/2 cc syringes for up to 50 units and 1cc syringes for up to 100 units."

So according to this, the 1/2 cc ReliOn syringes are marked in single units and do come in the 31 gauge short needle. Since the 1/2 cc syringes hold up to 50 units, you should be able to use those and get the exact markings you need.

The only thing I can think of is that Dr. B. is not quite comfortable with that 97 nadir at peak insulin time and she's afraid that Pebbles might possibly slide too low again.

It seems to be a process of everybody's needing to find their way here, because when you go back and look at Pebbles' insulin dosage for a bit, not long ago, you were told to increase her to 42 units twice a day. Not long after that, she started needing to have her insulin decreased a bit at a time until we're now down a total of 10 units daily--5 unit decrease per shot; that's quite a reduction when you think about it.

Dr. B. may want to play it cautious until Pebbles comes in to see her.

Every doctor has his or her own "rules" about how they manage diabetes. John's is that he wants everyone under 200 all the time. You also need to know how that particular animal handles the insulin before you can "get comfortable" with some bg readings.

Right now, Pebbles keeps doing everything so well that with what you've put together, she needs less insulin than she did before. She hasn't let any of us "get comfortable" about her insulin dose lately. :D

Testing Lucky at about 8-10 hours after breakfast and morning insulin would find him at 85 on Caninsulin/Vetsulin; on Iletin II Lente at the same time of day, you would see him at 102. After we got him on pork and he regulated, we knew from testing so much and at different times of day that there was not a large swing between his pre shot bg's and his post-shot ones. We also knew from experience with him that once you found "happiness" (right number of insulin units), he'd stick with that and be very steady on it.

The times that something was off, we could account for and correct--the weak Iletin II Lente, the heartworm med causing his bg's to soar, and the 1/4 pound he gained. He went back to his normal insulin dose with steady stable bg's after we fixed what was wrong with those things.

When we "discovered" what it took for Lucky--that he varied quite little and did well running "tight"; this may not have been right for somebody else but it was for him. Pebbles right now, still has some "surprises" she keeps coming up with for us, as she keeps needing less insulin. ;)

Talking with Dr. B. when you go to A & M should give you an idea of what her expectations are re: the range of Pebbles' bg's she hopes to achieve.

Kathy

[eyelostit]

http://i102.photobucket.com/albums/m115/sungduk/SulodeneBottle.jpg

This is what it looks like

[bgdavis]

Marianne,

Crissy has a 'bump' that looks very much like Pebbles'. She has had it for over 3 years and it's on the top of her head. My vet said not to worry it about it and didn't attempt to remove it. It hasn't grown over time. She did have another one behind her ear which she managed to scratch and it got infected. Because of the infection, it was removed.

Bonnie and Crissy

[rhodesian46]

Thanks Bonnie for the info. Just an update on Pebbles. I reduced the insulin Monday morning to 37 u Did a night time bg was 162
Tuesday at fasting 5:30 am-- 311
9:00 pm 254
Wed (today) 5:30 am 426
I think she is creeping up again Should i increase back to 38 and maybe get the happy balance with a snack if she goes too low? I haven't seen that pattern of too low just being cautious. I think 38 u is the happy number What do ya'll think?

[We Hope]

Marianne,

It sure looks like it. Try the 38 units, keep an eye on Pebbles' bg's and give a snack if need be. If you discover 38 is "it", you'll need to notify Dr. B. about that. :)

Kathy

[ladysmom06]

Hi Marianne,

Dr B said that the growth looks fairly benign Possible papiloma( wart). She will aspirate it in the 7th

Thats GREAT NEWS. Hugs to you and the gang.

Luv,
Lynne and Lady

[rhodesian46]

Hey ya'll,
Pebbles appointment with Dr B is this Tuesday We will be traveling then normal 2 hours to get there. She is now on 38 u No lows Haven't told Dr B about this But will tell her Tuesday. Hope and pray all of her blood work,stim, growth is normal. I get really nervous when I go MAybe it is because I haven't had a chance to get caught up with her last bill!. Will post Wed and let u know how everything worked out:)

[We Hope]

Marianne,

It sounds like 38 is the magic number! :) Pebbles is holding steady at that and I think she will get a good report from Dr. B. on Tuesday! ;)

Kathy

[Ricksma]

Marianne, we are keeping everything crossed here...hoping for a really good visit for Pebs. Ricky says to tell Pebbles that he is rooting for her...let us know how it goes...

Love and hugs, Teresa and Ricky

[Cara's Mom]

We are thinking of you and Pebbles and sending only very good thoughts with you on your trip to the vet!! Go get them, girls!!!

[rhodesian46]

Thanks everybody,
We switched to 38 units Thursday morning Today I didn't test her at fasting till evening fast Holy crud she was 428!!!!! Yesterday I did both fastings Morning she was 179( Great) evening fast 299(not so great) I have noticed though that she isn't very enthusiastic about eating her food No change in food Its that she eats some and then walks away I have to coach her by making her food mushier or adding a little parmesan Not normal for her at all. The last time this happened she vomited. I HOPE SHE IS NOT GETTING SICK!!God I worry about that. Maybe an infection is brewing Will take a good look at her skin after her bath. Thank god she is going in Tuesday MAybe I am worrying for nothing. Maybe she needs a decrease of her trilo Will post her Bgs tomorrow as I need to give this info to Dr B

[eyelostit]

I hope all the tests are OK, most of the time Niki will have a good am fast like a 170 then pm fast is 275 at 10 hrs which is was tonite, I waited until the 12th hour got a 290. I can't figure it at times, so I just fed 1/2 of her food wil check BG give shot then the other 1/2 of food, sometimes I have to do this.

Now when I check her 1/2 hr after food her BG could be lower at times before shot.

Do you take Pebbles for a walk before her evening meal? maybe her BG is low then the exercise makes the liver produce that glucogon. I think this happens with Niki on and off.

Tho your not supposed to when I get a high over 350+ i give 1 unit of insulin wait an hour check bg see if it goes down, when it does i feed then give less insulin after food.

I just don't like to feed Niki when her BG is above 300, cause then its going to go up even higher by shot time and then stays high till the insulin kicks in which can be 1 1/2 hr to 2 1/2 I never really know her body just acts like this, we don't have any set rules, Niki just does not follow the norm of 12 hr feedings. I've tried the 3 shots a day but that made matters worse.

Of course the vet told me not to feed her when it goes above 400 and to only give 1/2 her dose. but I know she is hungry.

I can only do what I think best for Niki, you are taking good care of Pebbles.

I can just imagine or can't possibly imagine what you and Pebbles are going thru with diabetes plus the cushings.

Hoping for a good day tommorrow:)

[rhodesian46]

Ok I am back from A & M,
Pebbles was very upset about going to see Dr B. I guess it is because she spent 3 days there when she was sick. Her back legs began to tremble and she heavily panted. They are all wonderful with her. Anyway they checked out her ear. No inner ear infection The outer part of her ear is red so they prescribed Tresaderm Is a steroid. She said it shouldn't effect her bgs Is that true? She was tender near her abdomen but not near her pancreas. Of course an ultrasound would give answers. Will watch. She mentioned that she has the impression that I just want to keep Pebbles comfortable. I replied yes but if you think that she needs an ultrasound then I will save and we will get one She said she may have a UTI or something like that.. I told her that I am trying to get caught up with her last stay of $1200. Dr B said it may be her arthritis and also I bathed her and picked her up last night in the tub also we put her in the Explorer today Had to pick her up. She yipped. I found some more growths on Pebbles last night. Dr B was confident that the growth on the side of her face was a wart as the other growths But the one I found last night was underneath her skin They shaved her and aspirated It is fine She had quite of bit of blood when she did the rectal. Dr B said she may have a polyp further in but the only way to tell is to put that camera up her butt.! She doesn't advise putting her down for this as with 3 endocrine disorders it is risky Poor Pebbles was so worked up that she vomited 2 x. Dr B doesn't think it was pancreatitis because of the matter. Did give her a cerenia (anti nausea )shot just to be on the safe side She is doing a urinalysis,blood work that they did in house was fine Pebbles isn't losing a lot of blood from the rectum She is concerned that her blood when doing the stim was like a milkshake. Dr Stone said the same thing . She is on low fat food. So she did a triglycerides. She said being lipemic can cause a greater chance of pancreatitis All tests will be back in a few days. She said medicine can be given to lower the triglycerides if they are high Does anyone know what meds they use? Or does anyone have a dog with that problem? Oh yeah aT4 was done too. The good news is that Pebbles gained a lb. She is 56 lbs on their scale. THey tested my one touch ultra meter with their venous draw. It was 31 pts lower than their lab. We had a long day Pebbles gave me a difficult time eating I kinda coached her to eat Maybe I was wrong doing that Hope not. Got out the tunawater and chicken broth as well Hope she keeps it down She is a bit shaky in the hind legs today E mailed Dr B and asked her if she vomits tonight could I give her the tablet form of cerenia. Also Dr B doesn't want Pebbles to have any more milk bones She has a small piece on her walk She said a small baby carrot would be good as an incentive for her. She is really tired It takes over 2 hours to get there.and 2 home. Hopefully she will feel better tomorrow

[We Hope]

Marianne,

Let me go through this bit by bit, OK?

Tresaderm--
http://www.1800petmeds.com/Tresaderm-prod10218-10218.html

"Each ml of solution contains 40mg thiabendazole, 1mg dexamethasone, and neomycin sulfate equivalent to 3.2mg of neomycin. Prior to use the affected area should be cleaned. Application and use of Tresaderm should be limited to a period of not longer than one week. Do not use in the eyes.

"What are the possible side effects of Tresaderm: Side effects associated with this medication are related to the individual ingredients. Side effects following the use of injected or oral corticosteroids include increased thirst and urination, vomiting, diarrhea and Cushing's syndrome following prolonged or repeated steroid therapy. Discontinue use and contact the veterinarian if sensitivity to neomycin, which may cause redness, irritation and swelling, occurs. Continue the medication and talk to your veterinarian about any side effect that seems unusual or bothersome to the animal.

http://www.petplace.com/drug-library/thiabendazole-tresaderm/page1.aspx

This drug is registered for use in humans and animals.

Human formulations: Mintezol® (Merck)
Veterinary formulations: Tresaderm® (MSD Agvet)

Precautions and Side Effects

"It is possible that the steroid component of Tresaderm®, dexamethasone, can be absorbed into the circulation. Chronic use can suppress the function of the adrenal glands."

http://petdiabetes.wikia.com/wiki/Steroids#Why_they_are_used

"For pets and people who are diabetic, the use of oral or injected steroids brings with it higher blood glucose levels.

"This is not to say that you should totally rule out any use of steroids with a diabetic pet, but need to be watchful regarding them. Ask if there is an alternative medication for the problem which is non-steroidal.

"If you must use steroids, try to use local or inhaled versions, which are less likely to raise blood sugar. Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary."

Cited links are on the wiki page.

Now--you may see some higher bg's, but I'd think if you do, they wouldn't be as high as if Pebbles was given an oral steroid or a steroid injection because this is topical (goes in the ear).

OK--to triglycerides now:

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

"Lipids or fats circulating in the blood.

"Hyperlipidemia is another term for too many lipids, or fats, circulating in the blood.

"They usually occur because of the hormonal imbalances associated with Cushing's Disease and hypothyroidism; treating them reduces the excess circulating lipids.

"A low-fat diet supplemented by omega-3 fatty acid geneally helps reduce them. Anticholesterol medication, as humans take, is also available."

Having lipids or fat in the blood is like people having high cholesterol because that's what it is for people too--excess fats in the blood. People change their diet--Pebbles has already done that :)--and take anti-cholesterol medication. Having diabetes can also put you at risk for having excess fats in the blood.

http://petdiabetes.wikia.com/wiki/Pancreatitis#Causes

Some possible causes of pancreatitis:

"Hyperlipidemia: or high fat content in the blood. The levels of fat in the blood often rise after eating, but for those without hyperlipidemia, this is a temporary state. Metabolic problems in both pets and people can prevent the removal of fat from the blood. Some studies show that hyperlipidemia can be a cause of pancreatitis. A low-fat or restricted fat diet is suggested for all diabetic dogs, as it may prevent pancreatitis."

Cited links are on the wiki page.

So Pebbles has three conditions which would make her more likely to have this problem--Cushing's, hypo-T and diabetes.

Dr. B. is right about the camera and the polyps--that's the same thing they do with people when they believe there are polyps in the bowel.

I can sure see why she was upset today--she hasn't been there since being so sick and had to stay for a couple of days that time. Can also see why today wasn't such a good day for eating--too upset. Hope things are less stressful tomorrow! :)

Kathy

[rhodesian46]

Hi, Pebbles is really not interested in food today as well Ate 1/2 I spoon fed the rest Am placing a call to Dr B this morning. Maybe she will want to put her back on the brat diet and stop trilo tomorrow tomorrow morning and give predilosone, Test results will be back tomorrow Get back with you later Have to go to work

[We Hope]

Marianne,

You're too quiet! :D

Kathy

[k9diabetes]

Hi Marianne,

I saw your somewhat more detailed post about stopping the trilostane from the Cushings board. Am very anxious to hear what's up with the testing and Dr. B's concerns.

From Cushings board:
Am waiting for he test results on Pebbles Dr B e mailed me last night and said that she was in emergency surgery and couldn't call me till today( Maybe)

She wants me to stop Trilo until she speaks with me.

Pebbles has been walking away from her food especially since her visit to A & M last Tuesday. We put her on anti nausea med and Tramadol( for pain) as she was limping.

I think picking her up and putting her in the SUV hurt her. I asked Dr B at the visit if Pebbles was going Addisonian She replied no.

If I remember correctly when the Trilo is too high it will cause inappetence? Am I correct?

She mentioned in her e mail that there will be a reduction to Trilo and not to give it to her today.

Pebbles is currently on 60 mg of Trilo Relatively low dosage for a 56 lb dog.

I am also concerned about the bleeding, mainly because it seems to be in concert with other things - the pain, lack of appetite, some vomiting that have been intermittent recently... If you can swing an ultrasound, I think it would be a good idea.

Is there an ultrasound person locally who could do one? Would save the wear and tear of travel, though sometimes the vet schools are no more expensive. We have a few mobile ones here - ultrasounds are all they do.

Most of the time, a topical steroidal ointment won't have much effect on blood glucose. Things like Tressaderm are broad spectrum - steroid, antibiotic, and I think antifungal. If it's an infection, you can go just with an antibiotic ointment.

We never used those preparations much because they all use neomycin as the antibiotic and Chris was allergic to it so I don't have experience with whether they raised his blood sugar.

Omega 3 fatty acids are usually a good thing regardless of the lipemia issue. Probably would be really good for Pebbles' coat. We mostly gave fish oil capsules after Chris had a reaction to something in DermCaps - made him pant like a fiend. Omega 3s are anti-inflammatory too so I would definitely favor putting her back on them as long as she didn't have a bad reaction to them.

Will be looking for more news. Hope Pebbles is feeling better!

Natalie

[rhodesian46]

Pebbles trilo has been reduced from 60 mg to 30 mg one day then 60 mg the next We will alternate I have stopped her trilo till probably Mon or Tues and willl resume the schedule that Dr B wants. Stim will repeat in 1 month Can't afford to do the stim and ultrasound at once. The rectal bleeding has not gotten any worse. She will palpitate again to see if there is tender spots still.She ate better tonight and hasn't been on trilo for 2 days now. Dr B wants me to double fish oil 2000 mg bid and wean her off the tramadol and human anti nausea meds in the next 3 days Her Thyroid value was perfect. Hey one good thing. Natalie read Louise's post on the cushings forum as she mentions about the nutritionist etc. And am I adding fat to Pebbles diet increasing the Fish oil? Shoot I am confused. have e mailed Dr B 2 x today will wait for her to reply and my questions will begin, She doesn't want to consider home cooking until we get everything else under control May want to go to Royal Canin low fat. I told her that I would like to home cook for her Hopefully Pebbles will begin to eat everything again. I did tell Dr B that I don't like hearing her say" Pebbles does have a lot of endocrine disorders and things against her" It makes me feel like Pebbles is a lost cause and isn't going to survive. We are still at 38 u bid of insulin Pebbles Bgs ae doing good. Will try to get an ultrasound if Pebbles continues to have inappentance etc. I just need to get caught up and start saving again. It tough when you don't have credit cards!!!!

[We Hope]

Marianne,

When Pebbles had to take the Tramadol before, you had appetite problems:



http://www.drugs.com/tramadol.html

"Less serious side effects may include:

"nausea, vomiting, constipation, loss of appetite;"

If you look at Trilostane too, you can find some of the same symptoms Pebbles has been having--vomiting and lack of appetite:

http://www.noahcompendium.co.uk/Dechra_Veterinary_Products/Vetoryl_10_mg_Hard_Capsules/-36949.html

NOAH Compendium UK--Vetoryl-Trilostane:

Contra-indications, warnings, etc
Adverse reactions:

"Lethargy, vomiting, diarrhoea and anorexia have been seen in dogs treated with Trilostane in the absence of evidence of hypoadrenocorticism."

Dr. B. wouldn't have told you to use the fish oil if it wasn't OK with Pebbles' low-fat diet. I agree with her that for now, these problems need to get ironed out before going back to home cooking.

Pebbles seems to have her Hypo-T, Cushing's and diabetes under good control with the insulin and other meds. Dr. B. may have just been saying this because with all of them, there can be times when you need to take care of other medical problems a little differently when a patient has these types of conditions than you do when he/she doesn't have them. One example would be using cortisone injections or oral meds. Temporary use of them would be little to no problem for someone without diabetes--using them with diabetes in the picture can change that.

If I remember right, A & M doesn't take credit cards or Care Credit--is it possible for you to find a way to get the ultrasound done somewhere that would take either of them? If so, you might be able to get the stim at A & M and the ultrasound locally, with the results sent to Dr. B.

Girlfriend, keep your chin up--there are two votes that Pebbles isn't a "lost cause"--yours and mine! :)

Kathy

[rhodesian46]

I have checked with the vet down the road and another All want $250 -$300 A & M wants $250. I will check around some till next visit to A & M in 30 days and if not if Dr B thinks it is necessary and her abdomen is still tender then I may have them do it right then and there. They offer 6 months to pay off with a wee bit of interest. If you remember I had had an ultrasound done with the bad vet This was before A & M did one It wasn't read by an Dr but by an ultrasonagrapher which in my opinion doesn't have as much experience.as a doctor The bleeding has been going on for a year now but the tender abdomen was new If she continues to refuse food, of course I will get it done immediately.

[rhodesian46]

Pebbles was fussy eating this morning I was pleading with her She is on day 3 no trilostane. Dr B got back to me and wants to give the fish oil a chance( 3-4 weeks) Then she wants a triglyceride check as close to fasting as I can The good news is that out vet is open till 5:30 pm which would be perfect to have her tested then She thinks though that there will be a dietary change though but wants to give the fish oil a change pebbles was on 1000 mg bid She wants me to increase slowly:watch out for So she said 200 mg morning 1000 mg evening for a few days then go 2000 mg bid. AM not sure when to start the trilo back up again The protocol is 7 days for a non stimulatory ACTH test PLus the fact that she isn't anxious about eating all of her foods She has consulted with the senior IMS at A & M and he suggested going 60 mg of trilo one day 30 the next. I don't know why but will put a call into Dr B and ask her. Also need to tell her about Pebbles not willing to eat. I know the lack of appetite could be caused from low cortisol. Thats why we have stopped the trilo. Am writing the questions down so I don't forget to ask her. I don't want to switch to another food like Royal Canin. But tonoght Pebbles did eat tonight Hurray Will post tomorrow

[We Hope]

Marianne,

I have an article from last year's DVM Magazine re: Hyperlipidemia in Dogs and Cats. It really gets technical, so let's see if we can grab some of it here.

http://veterinarymedicine.dvm360.com/vetmed/Feature/Hyperlipidemia-in-dogs-and-cats/ArticleStandard/Article/detail/456193

Hyperlipidemia in dogs and cats
Publish date: Sep 1, 2007
By: Justin D. Thomason, DVM, DACVIM (small animal internal medicine), Bente Flatland, DVM, DACVIM (internal medicine), Clay A. Calvert, DVM, DACVIM (small animal internal medicine)|Veterinary Medicine

http://veterinarymedicine.dvm360.com/vetmed/data/articlestandard//vetmed/372007/456193/i1.gif

And there you see Pebbles' Hypo-T, pancreatitis and diabetes making her more apt to have the problem.

Some of the problems you've been seeing may be due to the hyperlipidemia:

http://veterinarymedicine.dvm360.com/vetmed/data/articlestandard//vetmed/372007/456193/i4.gif

There's the loss of appetite--anorexia--and possibly the cause of the abdominal area pain.

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=456193&sk=&date=&pageID=3

"Lipoprotein lipase is necessary for removing VLDL and chylomicron fatty acids from the blood.4,7 Lipoprotein lipase activity is increased by heparin, insulin, and thyroid hormone.3,9 So patients with diabetes mellitus, pancreatitis, or hypothyroidism tend to have hyperlipidemia.9"

"Although clinical signs and history may be consistent with pancreatitis, laboratory data and imaging studies may fail to support a diagnosis of pancreatitis."

And you initially thought Pebbles was having another problem with pancreatitis.

http://veterinarymedicine.dvm360.com/vetmed/data/articlestandard//vetmed/372007/456193/i9.gif

The fish oil-omega-3 fatty acids.

http://veterinarymedicine.dvm360.com/vetmed/data/articlestandard//vetmed/372007/456193/i10.gif

This link shows you the low-fat prescription diets; think Dr. B. brought up Royal Canin because it has the least fat on the list of them.

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=456193&sk=&date=&pageID=7

"The prognosis for patients with secondary hyperlipidemia is favorable with effective treatment of the underlying disorder."

The cortisone-type steroids can be used as an appetite stimulant:

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/190302.htm

"Drugs used as appetite stimulants in monogastrics (beings with only one stomach, unlike cows, etc.) include B vitamins, glucocorticoids, anabolic steroids, benzodiazepines, and cyproheptadine."

http://www.merckvetmanual.com/mvm/htm/bc/tphm02.htm

Let's hope that fish oil is already doing some good! :)

Kathy

[rhodesian46]

Dr B called this morning. I know that she would rather e mail me unless it is important. Well to me it was important. She thought that the trilo could only be gotten in 30 mg or 60 mg from the manufacturer in England. I told her that I get her trilostane compounded from AZ. She then said 45 mg a day would be fine She doesn't want me to start her back on trilo till this Sat. Also she explained to me that the fish oil is a anti inflammatory and that she would like to try this for 3-4 weeks Watch out for diarrhea I am a bit confused but what else is new! Pebbles did eat this morning thank the lord. I have been a basket case watching every move she makes. Now I have to watch her poop!! Haven't done a lot of Bg testing Will do a fast tonight.

[We Hope]

Marianne,

Pass these links on to Dr. B.--Trilostane (Vetoryl) comes in 10mg and 120mg strengths from Dechra/Arnolds also:

http://www.noahcompendium.co.uk/Compendium-datasheets_by_AI/Active_Ingredients/-24874.html

Trilostane-Vetoryl--Dechra/Arnolds (UK)

http://www.noahcompendium.co.uk/Dechra_Veterinary_Products/Vetoryl_10_mg_Hard_Capsules/-36945.html

Vetoryl 10mg Hard Capsules

http://www.noahcompendium.co.uk/Dechra_Veterinary_Products/Vetoryl_30_mg_Hard_Capsules/-45408.html

Vetoryl 30mg Hard Capsules

http://www.noahcompendium.co.uk/Dechra_Veterinary_Products/Vetoryl_60_ACY-nbsp_ADs-mg_Hard_Capsules/-27724.html

Vetoryl 60mg Hard Capsules

http://www.noahcompendium.co.uk/Dechra_Veterinary_Products/Vetoryl_120_ACY-nbsp_ADs-mg_Hard_Capsules/-27735.html

Vetoryl 120mg Hard Capsules

http://www.masters-uk.com/veterinary/home.php

Masters (UK) offers all 4 strengths of Vetoryl and information re: obtaining it.

Now you see where the 60mg one day and the 30mg the next came from--it would average out to 45mg for each day.

You also get to show her you knew something she didn't. :D I've always used the NOAH information when I needed something about Trilostane as it's not available here unless you either import it or have it compounded as you do. What I like about NOAH is that it gives you all information about the drug. NOAH also has information in it on the Insuvet line of beef insulins sold only in the UK and must be imported here unless you are able to use compounded beef PZI.

You're playing both ends to the middle, here, girlfriend. You watch what goes in Pebbles' front end and now you need to watch the other end too! :D

Hang in there--eating without hassles is a good sign! ;)

Kathy

[rhodesian46]

Thanks Kathy,
I think I will tell her in person. I think she is the kind of vet that doesn't like to be corrected if you know what I mean That is one of the reasons I called her instead of e mailing her And you know I would hate to have her not as helpful She has been great with Pebbles She called the script for te trilo in with 5 mns Even the pharmacy was surprised. Took Pebbles bg at fasting It was 283 Oh well tomorrow she will do better Haven'rt beed worried abouther bgs for the past couple of days

[We Hope]

Marianne,

I know what you mean; am grateful that it's always a two-way street with mine. Many times in the course of helping Lucky, it would be a "brainstorming" session with the two of us batting thoughts, information and ideas back and forth.

Dr. B. has been a fantastic help with Pebbles!

I think Pebbles' bg's are sort of "sneaking" back up because she's been off the Trilostane for a bit and now starting to eat regularly again. Also think you'll like what you see from your meter better when she goes back to taking it as per Dr. B ;)

Keep us posted as to how things are going! :)

Kathy

[rhodesian46]

QUESTION? PEBBLES HAS BEEN OFF TRILO FOR 5 DAYS NOW Will get her increase of 45 mg of Trilo this Sat. I have been seeing more urinating and water drinking. Is this because her cortisol level is rising? I dare not test her Bgs I would think that her Bgs will get back to normal with in a few days of trilo?:confused:

[We Hope]

Marianne,

Since you've not tested Pebbles bg's, we don't know what they are. It could be her cortisol rising which causes the PU/PD and it could be that the cortisol is also driving her bg's which in turn causes PU/PD.

What I hope you've been doing is using urine testing sticks which also test for ketones so you can see that she's not getting into any danger from that.

My thought is that since you've been seeing Pebbles' bg's start creeping up after a while off the trilostane, that the cortisol is most likely rising without any meds to keep it in check. The cortisol, in turn, can raise the bg's.

I'd personally like you to test Pebbles' bg's so you can see how high they may be--and, if necessary, contact Dr. B. about increasing her insulin if need be until she can go back on the trilo and the med gets a chance to start controling her cortisol properly again.

Kathy

[rhodesian46]

I beat you I already tested her at fasting tonight She was 124. Will test her at least 2 times at fasting every day So I am assuming her Bgs have been fine Looked at my posts I tested 2 days ago. It feels like I haven't tested in years I would then assume that the cortisol is rising due to being off trilo E mailed Dr B and have cancelled Pebbles curve for this weekend as she will only be on Trilo for a day. If I remember correctly that her Bgs weren't in check until the cushings was well controlled. It has been so long I can't remember I believe I have also read this on the Cushings forum. What I am also afraid of is that there will possibly be an dosage change in her insulin SO I will need to watch her Bg's closely You never know since when does Pebbles ever follow the textbook ?

[We Hope]

Marianne,

Glad you're on your toes, girlfriend! :D

Your testing proves to us that the PU/PD isn't coming from the diabetes, so we'll need to say that it looks like it might be Cushing's related. I think after the reading you got we can say that the Hypo-T seems to be well controlled too.

When you have the excess cortisol of Cushing's driving blood glucose, you're right in that until there's a "stop" put to the excess cortisol by medication working, the bg's will be high until that happens. This is why some dogs go into a state of temporary diabetes when they have Cushing's; when the Cushing's is treated successfully, their bg's return to normal levels without any need to have insulin to control them.

Agree with you that you'll need to be extra-watchful after Pebbles goes back on the trilo--to be sure that the bg's don't suddenly drop. She's doing just great with the diabetes now! :)

Pebbles prefers to write the books and not read them--too bad she's not getting any royalty checks for all her hard work! :D

Kathy

[rhodesian46]

You are so right A book? Did you say more money? Maybe Pebbles will sign a book deal? I think she deserves some designer sunglasses!!! MAybe Chanel?:D:D Maybe I will get her some fake hair where it didn't come back in Maybe extensions??

[We Hope]

Marianne,

If you go with the hair extentions, I think you could sell the rights to the story and photos to People--she'd be a breadwinner for sure that way! :D

Kathy

[eyelostit]

Just checking on you and Pebbles, I hope things are getting better, you guys have been thru alot. Marianne I give you and a lot of other members credit (more than credit, I can't think of the word) for being able to handle the cushings and the diabetes.

With Niki its the diabetes, with my poor Chief it was the cushings, and that was hard enough for me.

I can't add anything to what's been posted, but your a great mom.:)

[rhodesian46]

Thanks for the compliment!! Pebbles is eating fine She has been off the trilo for almost a week now I am starting a lower dose ( is it comes in the mail today) tomorrow(45 mg) I found some beef broth at Wal Mart the other day It is their brand and comes in a 32 oz cardboard container It has no fat andno sugar I asked Dr B if Pebbles can have this She said that is fine So far no diarrhea from the increase in fish oil I will have her triglycerides tested in 3 weeks and see Dr B on Nov 17th for Pebbles stim again Hopefully this is a good dosage as the testing and the dr B's charges is not allowing me to get caught up. Pebbles is a handful with three endocrine disorders Can't say that it isn't stressful for me I worry that she could get pancreatitis again, Am really going to push the home cooking next month Hopefully Dr B will think this is a good idea She thinks we will have to change anyways. Íhe has her sassy attitude back Howling up a storm

[We Hope]

Girlfriend,

Attitude is EVERYTHING!

Look at the total dog and she's telling you she's doing fine, thanks! :D

Kathy

[k9diabetes]

Nothing to add Marianne... just hi, glad to hear the drop in Trilostane is making Pebbles feel better!

Natalie

[rhodesian46]

Bg's are a little high She was 410 4 hours after shot last night and 383 at fating this morning!!Hopefully they will decrease as the trilo get into her system!

[rhodesian46]

PEBBLEs was rushed to Texas A & M today This morning he refused to eat at all and was crying. I gave her a little broth and chicken and administered some tramadol for pain. It seemed to calm her down. By the time I got home from work she was howling and screaming. She ended up drinking lots of water and throwing it up So here my husband raced over 2 hours I lay in the back of the SUV trying to calm her down I called A & M and said that Pebbles will be in in 2 hours Dr B said no pain pills as her last was at 10:30 am today They wanted to be able to give her pain meds in her IV. I tried to rub her belly,calm her down There was not one time that this dog stopped screaming. my husband drove over 80 mph. I wasn't sure where she was hurting as anywhere I touched she yipped. So we got her there to emergency. They quickly got her back there to look at her and got pain meds in her The ER Dr came in and said that they ran some basic blood tests. She is concerned that Pebbles is severely dehydrated and that her kidney values are normal.Didn't think to ask her what they were. She said a dog doesn't get this dehydrated from one day of vomiting. Pebbles had been drinking and eating fine for the past week or so Pancreatitis could cause this but she wasn't sure at this time. She also when touched Pebbles she yipped no matter where she tried to feel. She wanted her to stay overnight to settle down and tomorrow morning they will check her more thoroughly. A snap test will be done tonight. I failed to ask any more questions as I am thinking where am I getting this money from? They wanted $300 tonight as they seem to think her care just for tonight will be around $600. It was $100 for the exam and $200 for ICU tonight and whatever tests they will do not including also and additional $250 for the ultrasound. I am sick to my stomach trying to figure where I will get this money with no charge cards at all. I don't want to have to put Pebbles down because I can't pay for her care!!! I am at wits end and so wish that I didn't push the issue of helping everyone out with vet bills if they need us to Now I am in the same position and I need help. Will post tomorrow after I hear from the vets there. Thanks for listening ya'll. I need to relax and try to sleep!

[We Hope]

Marianne,

Take it easy and take things one step at a time. Right now, Pebbles is in the place she needs to be to get the help she needs.

I hope everyone you gave a hand to will now do the same thing you did for them and give you one in return.

I don't think they would be cruel enough to make you do that. There must be some type of way to enter into an agreement to pay them as long as you can't use credit cards or Care Credit at A & M.

Somehow, I believe you'll find a way to pay these bills for Pebbles--let's find out what's wrong and how it can get taken care of for now, though.

Get some rest if you can, and please let us know how Pebbles is doing!

Kathy

[rhodesian46]

Thanks Kathy
I am just totally stressed. Will post tomorrow as the Dr when he/she comes in will take at look at Pebbles. Dr B isn't there for 2 weeks as the Dr's there do research every 6 weeks and aren't on call at all.

[We Hope]

Marianne,

When things happen like this, the only way you can get through them is to go one step at a time.

Taking too many steps at a time only puts more stress and worry on you. You've given them the "up front" money they asked for, so that's taken care of right now.

The next step is for them to find out what's wrong with Pebbles and see what they can do about making her feel better. You should learn more about that tomorrow, so try to get some rest--you need it.

Hang in there--Pebbles needs you to!

Kathy

[k9diabetes]

Marianne,

I'm just getting the news. Will call you tomorrow. I hope some pain relief will give Pebbles a restful night and that there will be good news tomorrow.

Natalie

[eyelostit]

Just checking to see if you came to Nat's board, I am so sad for you and poor Pebbles I hope things are ok tommorrow.

[rhodesian46]

Thanks ya'll My cell phone didn't ring in the middle of the night No news is good news. Was worried that she wasn't going to make it and I would get that phone call from the Dr.Will post when I hear something The Dr said that I will get a call first thing today.

[CarolW]

Sending our good wishes to you and Pebbles, Maranne. Wish I could help financially, but I'm begging, myself! I hope somebody will help you out. But Kathy is right - one step at a time. Sending tons of love, hugs, and all possible healing energy to Pebbles.

Tue, 21 Oct 2008 08:01:58

[bgdavis]

Marianne,

Hope Pebbles is settled and feeling better.

Bonnie and Crissy

[k9diabetes]

If anyone would like to donate to Pebble's care at Texas A&M they will take payments directly over the phone with a credit card number.

I picked up the contact information here: http://vmth.tamu.edu/contacts.shtml

I called the Small Animal Hospital (979.845.2351) and was transferred, probably to the Billing Department (979.862.4325).

You can simply reference the patient's name, Pebbles, and Marianne and let them know Pebbles is currently in the hospital there.

Natalie

[Cara's Mom]

Marianne, our thoughts are with you and Pebbles! But please, take care of yourself too!
Cara and Polly sent their love to Pebbles and you.

[k9diabetes]

Marianne has a lot of different forums to post to and it looks like her update did not wind up here. This is from this morning:

Thanks everyone for the sites but most either ( Like IMom) aren't accepting applications at this time or Pebbles doesn't meet the criteria AAHA one is for hospitals that are AAHA accredit A & M isn't one of them and don't take care credit I have $500 on the care credit card and out of luck using it. Have heard from Dr Quinn from A & M Pebbles still isn't eating but is alert and responsive She hasn't vomited which is a good sign. She is on IV fluids and is not getting any insulin at this time until she eats. Dr Quinn said that Pebbles is awful anxious and is not comfortable yet with the staff She is still in ICU and will remain there for at least Thursday I asked how Pebbles could be severely dehydrated last night and she said that Pebbles was moderately dehydrated She is not the same Dr I seen in ER. She wants to do a cortisol level ( not a complete ACTH pre and post) as she wants to rule out an Addisonian crisis. For those who are not familiar with Pebbles she has Cushings.Diabetes and is hyperthyroid. Addisons disease is producing less cortisol and Cushings is producing too much .Pebbles Acth stim 2 weeks ago was non stimulatory She was off trilostane for a week( protocol for Trilostane) and then started back on Trilo 3 days ago at a lower dosage(45 mg) If indeed she is too low on cortisol they will take her off trilo and treat accordingly. The results for that test will be in tomorrow. If he cortisol is fine then she wants to do an ultrasound but doesn't want to spend that money yet The ultrasound is $ 250. Pebbles bill for overnight so far not including today is $633.00. ICU per day is $300 not including any more testing THey did a snap test( test for pancreatitis) That has come out positive. I am not sure if that is 100% reliable Denise comment on this please. I am at ease now that I know that she did well last night. am still stressed out on the money issue big time. Wish I had the money to drive 2 hours to see her I know she would eat for me I hope that she does have Addisons as this would explain why she wasn't hungry and vomiting I had a dog for 8 years with Addisons Disease For me that would be wonderful news I do miss her as it such a habit for me to take care of her The staff will call me this afternoon for an update Thank you for your thoughts and prayers Hopefully we have good news tomorrow and she eats

[rhodesian46]

Spoke to the 4th year student at A & M. Pebbles is still refusing to eat They haven't given her any insulin but have a plan as far as this goes. If her Bg's are a certain amount then they will give a certain amount of insulin. Se said that Pebbles when they come in a check her gets up and paces. THey fell that it would be good for her if I went to go see her Maybe she would eat for me. They are treating her aggressively for pancreatitis and may do another test tomorrow to confirm The snap test can give false positives but this other test would tell them for sure Dr Quinn is waiting for the result of her cortisol level before she orders any more tests They are trying to feed Pebbles every 8 hours as they want her to remain calm She has been kinking her iv's and they are constantly fixing it. They have done some bg testing and are getting blood from her ear. I told them Pebbles doesn't like that to get the blood from her callous like I do They have lowered the anti nausea meds as she hasn't vomited since she got there yesterday. So if she eats tomorrow morning and the tests come back as Addisons I will not make the trip. If any different I will be on the road by 12 noon with some chicken,broth and rice She is presently turning down their chicken My poor husband does all of the driving Keep in mind he just had a rotator and bicep tear done last week and is in a sling!!! But if I can get her to eat I will be there. SHe is probably really scared. They have advised me to come see her as they think it would help.SO hope and pray she eats, I appreciate all of your concerns, I am still a basket case It is all I think about Pebbles, Pebbles Pebbles!!! It is so strange not having her here Will post more tomorrow You guys are great!!!!

[We Hope]

Marianne,

All of this sounds VERY good! I think some of this is because all of them are strangers to her--even Dr. B. is away now. Also think she's eager to get out of there, but that can't happen until they have the test results.

Pebbles will get better, will get out of A & M and come home where she belongs! ;)

Get some rest, girlfriend--your "jewel" will be back in the "crown" soon! :D

Kathy

[Dollydog]

Hi Marianne,
Just getting caught up with Pebbles and hope she's home real soon, take care,
Jo-Ann & Lady

[rhodesian46]

Am going to see her today with turkey. broth and rice Will arrive 3 pm central time Will post laster tonight!! Thanks guys!!!!

[k9diabetes]

You guys drive carefully, share a hug from us with Pebbles, and let us know how it goes when you can.

Natalie

[ladysmom06]

Marianne,

Hoping the turkey works again. Sending tons of prayers and hugs to all of you. Have a safe trip and keep us posted.

Luv,
Lynne and Lady